Locums: The Big Canary in the Emergency Medicine Coalmine

[deleted128562]

.

---

Members don't see this ad.

 

[KGflyboy]

I got a phone call last week offering $90/hr for locums work in the Virgin Islands. I don't care how good the weather is, how pretty the beaches are, or how much "fun" you tell me I will have there. I'm not working for $90/hr, and anybody who does is driving down the rates for everyone who actually has common sense and avoids junk offers like that.

 

[gamerEMdoc]

$200-220 an hour range

Yeah that is absurd considering you aren't getting paid any benefits. I do think that some rural places that see 1 pt/hr or less may not want to justify paying more unless they absolutely can't get anyone else. I can see that. But if asked to see 2 pt/hr as a locums at a busy place for 200/hr? Nooope.

I've got a few former colleagues that own their own locums company and still get decent rates. But they are good/quick docs, so places will hire them for their quality. They have good word of mouth.

For someone just getting into locums, that no one knows, maybe you are just facing the lower tiers of salary? I don't know.

 

[thegenius]

I got a phone call last week offering $90/hr for locums work in the Virgin Islands. I don't care how good the weather is, how pretty the beaches are, or how much "fun" you tell me I will have there. I'm not working for $90/hr, and anybody who does is driving down the rates for everyone who actually has common sense and avoids junk offers like that.

Just curious, why would you fault some ER doc for taking that job?
It's not for you, it's probably not for most ER docs. But there might be a few who are willing to take it.

 

[KGflyboy]

Just curious, why would you fault some ER doc for taking that job?
It's not for you, it's probably not for most ER docs. But there might be a few who are willing to take it.

Because the pay is so low it devalues our profession. $90/hr would not be enough to pay off the cost of becoming a physician.

 

[Rekt]

This is the future. Can thank the developing over supply and the CMGs

 

[thegenius]

Because the pay is so low it devalues our profession. $90/hr would not be enough to pay off the cost of becoming a physician.

I hear where you are coming from. but I don't totally look at it that way. Anymore than the folks who want to live in Colorado and make $160/hr. They could make more than $100 more elsewhere. Maybe even in the next state over.

I think it's fair to pay people what they are willing to take. If some dope wants to live in the Virgin Islands (not even a US State) and make $90/hr then so be it. I bet that's more along the line of what doctors make in places not called the US of A

 

[miacomet]

Yup.
Specialties where you don't have your own patient panel (EM, Anesthesia, Rads, ICU) are doomed. CMGs can flood the market with residents and you just have no bargaining power.
Not a great time to be going into EM.

23% increase in positions from 2012-2017: Press Release: 2017 NRMP Main Residency Match the Largest Match on Record - The Match, National Resident Matching Program

 

[gamerEMdoc]

The problem with the belief that the market will be so flooded we will all make $100/hr is that is assumes people will still continue to go into EM to flood the market. Many people are willing to do this job for 200/hr and benefits. But if you think this field will be popular among students at $90/hr, I find that hard to believe. There is a point where supply (em docs) will start going down if the market gets oversaturated and salaries drop.

Demand was high For docs for a long time, salaries went way up over a decade are so, and they exploded in some areas giving people a false sense of what they’ll always make. So supply increased accordingly, now salaries readjust. I just dont see there being this crazy bottom where we will all be seeing 2 pt/hr and only making 150k/year. I believe the market will level things out. As salaries get lower in one area, people will stop trying to flock there. If salaries get low across the board, docs will do something else, retire, etc and students will stop going into EM.

We point to areas with lower salaries and say the market is flooded with docs. But there’s still lots of places that arent flooded with docs that still pay well. You cant expect to be paid the same in an area where there are 1000 EM docs looking for work as someone that works in a place that has been trying to hire someone for years. Market forces are going to dictate salary.

Everyone loves capitalism until it effects them. In many cases, this is just the hand of the market at play.

 

[gamerEMdoc]

Also, as a reminder, once again, EM salaries rose on a national average last year As it has for the past decade. Gains in some places. Losses in others. But the national average continued to improve. If money is your biggest driving factor, you have to go where the money is.

 

[miacomet]

Sure, people may not want to do this for 150k a year, but what other option will the hordes of new grads have?
Big issue is it's just plain hard to find jobs in a lot of places right now, and I don't just mean Portland, Seattle, Utah, NYC, and SF. I just don't see this getting better in the near future.
And who cares if EM is popular or not? If US grads won't take the slots, FMGs will. Once the slots are there, someone will fill them.

We need to advocate, hard, for more real fellowships for EM docs.

BTW, I scanned the locums boards. EM used to be the biggest, now it's Gen Surg and Ob-gyn. Those fields will always be in demand.

 

[gamerEMdoc]

I have former residents practicing all over the country. Pacific NW. Appalachia. New England. Long Island. Texas. Carolinas. California, Florida, etc. They still sign contracts as early as their second year. I have yet to have a resident want a job in some state and not land a reasonable contract in that state. I look at their contracts. Most make way more than I do. Im not saying that their isnt tight markets in some places, but my experiences with residents in the job market is not reflected in all the doom and gloom I see. That doesnt mean we may not get there, we may see a big downturn, and I definitely get the fear. I just dont believe its as bad as many make it out to be based on my own experiences and the actual data and reports published on EM compensation.

 

[miacomet]

I have former residents practicing all over the country. Pacific NW. Appalachia. New England. Long Island. Texas. Carolinas. California, Florida, etc. They still sign contracts as early as their second year. I have yet to have a resident want a job in some state and not land a reasonable contract in that state. I look at their contracts. Most make way more than I do. Im not saying that their isnt tight markets in some places, but my experiences with residents in the job market is not reflected in all the doom and gloom I see. That doesnt mean we may not get there, we may see a big downturn, and I definitely get the fear. I just dont believe its as bad as many make it out to be based on my own experiences and the actual data and reports published on EM compensation.

Wow, including Portland, OR and SLC, UT? Denver? Impressive,

 

[Rekt]

Also, as a reminder, once again, EM salaries rose on a national average last year As it has for the past decade. Gains in some places. Losses in others. But the national average continued to improve. If money is your biggest driving factor, you have to go where the money is.

Unfortunately. After now being on the other side, medical students are so damn clueless it's unreal. A lot of people I've interviewed and interacted with dont even know what a CMG is or an SDG. They see the fake salary figures posted by ACEP aka CMG bunghole suckers and flock to the specialty. There's no way EM is going unfilled in the near future, thus we'll be extremely over saturated and we'll be hoping to make 150/hr most. At that time, then they'll realize it's not worth it.

 

[ace_inhibitor111]

The problem with the belief that the market will be so flooded we will all make $100/hr is that is assumes people will still continue to go into EM to flood the market. Many people are willing to do this job for 200/hr and benefits. But if you think this field will be popular among students at $90/hr, I find that hard to believe. There is a point where supply (em docs) will start going down if the market gets oversaturated and salaries drop.

Demand was high For docs for a long time, salaries went way up over a decade are so, and they exploded in some areas giving people a false sense of what they’ll always make. So supply increased accordingly, now salaries readjust. I just dont see there being this crazy bottom where we will all be seeing 2 pt/hr and only making 150k/year. I believe the market will level things out. As salaries get lower in one area, people will stop trying to flock there. If salaries get low across the board, docs will do something else, retire, etc and students will stop going into EM.

We point to areas with lower salaries and say the market is flooded with docs. But there’s still lots of places that arent flooded with docs that still pay well. You cant expect to be paid the same in an area where there are 1000 EM docs looking for work as someone that works in a place that has been trying to hire someone for years. Market forces are going to dictate salary.

Everyone loves capitalism until it effects them. In many cases, this is just the hand of the market at play.

The issue is the supply won’t ever decrease because it is dictated by the number of residencies for the most part which has exploded. Only way for it to decrease is if residencies close down or if there’s some sort of mass retirement (not likely, with the average age for EM being about the same for the past decade or so). Otherwise residencies will just fill to the brim with lower par applicants or IMGs, whatever it takes to fill capacity, and more EMs will be continue to flood the market every year.

 

[TooMuchResearch]

We have recently minted docs in our group that don't know what CMGs are.

Unfortunately. After now being on the other side, medical students are so damn clueless it's unreal. A lot of people I've interviewed and interacted with dont even know what a CMG is or an SDG. They see the fake salary figures posted by ACEP aka CMG bunghole suckers and flock to the specialty. There's no way EM is going unfilled in the near future, thus we'll be extremely over saturated and we'll be hoping to make 150/hr most. At that time, then they'll realize it's not worth it.

 

[TheSingularity]

The weird thing about the locums market is that whereas some locums positions I've seen posted are for about $200/hr in bumfuq, I'm seeing places in seemingly "low paying" locales (think northeast) paying over 230/hr. Maybe it's just the locums agencies being thrifty?

 

[bronx43]

The problem with the belief that the market will be so flooded we will all make $100/hr is that is assumes people will still continue to go into EM to flood the market. Many people are willing to do this job for 200/hr and benefits. But if you think this field will be popular among students at $90/hr, I find that hard to believe. There is a point where supply (em docs) will start going down if the market gets oversaturated and salaries drop.

Demand was high For docs for a long time, salaries went way up over a decade are so, and they exploded in some areas giving people a false sense of what they’ll always make. So supply increased accordingly, now salaries readjust. I just dont see there being this crazy bottom where we will all be seeing 2 pt/hr and only making 150k/year. I believe the market will level things out. As salaries get lower in one area, people will stop trying to flock there. If salaries get low across the board, docs will do something else, retire, etc and students will stop going into EM.

We point to areas with lower salaries and say the market is flooded with docs. But there’s still lots of places that arent flooded with docs that still pay well. You cant expect to be paid the same in an area where there are 1000 EM docs looking for work as someone that works in a place that has been trying to hire someone for years. Market forces are going to dictate salary.

Everyone loves capitalism until it effects them. In many cases, this is just the hand of the market at play.

You do realize that it’s no longer like the 90s where the number of residencies significantly outnumber the number of applicants. With the rising number of medical school expansions and FMGs, there really are not many unfilled residency spots in the country of any specialty. It’s simply musical chairs.
If one specialty becomes a dumpster fire, top applicants will shun it and weaker applicants will fill the seats.

 

[Fox800]

Some of my recent interactions/experiences:

• Rural hospitals in Texas 2-3 hours from a major city. Will not reimburse travel or lodging. One told me "we prefer to hire PAs/NPs", offered $89/hr, and did not cover travel or malpractice. This was literally the worst offer I've ever heard of. I then realized he was literally offering me PA/NP pay and then cannot figure out why physicians don't want to work there. Then proceeded to ask if I'd have any interest being a medical director. Texas does not have independent practice for midlevels.
• So far have only found two rural sites with any needs within 90 minutes of where I live. One paying $89/hr and one paying $120/hr.
• 2 hours from my home (with no traffic): FSED $170/hr with an "extra $10 for every disposition". I'm told it is not slow either, more like 2+PPH. The group had to scrounge the bottom of the barrel to offer me that.
• One employer interviewing in my immediate area. $200/hr W2 job. Makes you sign an exclusivity clause so you can't work anywhere else. Got 200 applications and hired 7. Take it or leave it.
• USVI: $125 per hour with travel. Hospital is not a cakewalk to work at. Could not get the director to e-mail me back when enquiring about shifts as I had time off and just wanted to see the islands/pick up some work on the side.
• Denver (USACS) $145/hr with a 4-year buy in. Barf. Next.
• Portland: $200/hr to work at a dysfunctional, older ED.
• I have recently interacted with a few of the large locums groups: Weatherby, Global, Hayes. I ask for $275/hr with travel covered, $240-250 for a slow rural site (1PPH or less). I figured this is fair for the inconvenience of traveling. When I mention these numbers they disappear/ghost. They consistently offer $220/hr to work at busy places in states with bad or mediocre med-mal environments and think it's a fair deal.
• I found one place offering $285/hr at a typically busy place and $240/hr at a slow site. I think THAT is fair.

Buyer beware when it comes to EM these days.

 

[miacomet]

So, aside from the ever-optimistic @gamerEMdoc, it looks like EM is in the beginning of a death spiral, along with anesthesia, rads, rad onc, and maybe ICU. The party never lasts unless you have your own patients.

What's an early to mid-career doc to do? Palli? Occ Med? Pain? There just aren't a bunch of great escape strategies, no? This isn't IM with cards, GI, and even ID as outs.

 

[Fox800]

So, aside from the ever-optimistic @gamerEMdoc, it looks like EM is in the beginning of a death spiral, along with anesthesia, rads, rad onc, and maybe ICU. The party never lasts unless you have your own patients.

What's an early to mid-career doc to do? Palli? Occ Med? Pain? There just aren't a bunch of great escape strategies, no? This isn't IM with cards, GI, and even ID as outs.

Fellowship if you think it'll benefit you. CCM or pain would be my picks. VERY different lifestyles obviously. CCM job market is still hot, but you may be losing money across the board compared to EM.
Chase $$$ locums if you're willing to go far (midwest seems to be the hold-out for this).
Pay off your debt, invest in things outside of medicine.
Go work in Australia or Canada, they seem to be the only two first world English-speaking countries that come close to paying what we should get here.

@gamerEMdoc I'm sorry buddy but your head is in the sand. The days of us getting bombarded with recruiters e-mailing about $350/hr to work in Texas/the Southeast are over. This is a natural byproduct of over-supply.

 

[miacomet]

Fellowship if you think it'll benefit you. CCM or pain would be my picks. VERY different lifestyles obviously.
Chase $$$ locums if you're willing to go far (midwest seems to be the hold-out for this).
Pay off your debt, invest in things outside of medicine.
Go work in Australia or Canada, they seem to be the only two first world English-speaking countries that come close to paying what we should get here.

GamerEMDoc I'm sorry buddy but your head is in the sand. The days of us getting bombarded with recruiters e-mailing about $350/hr to work in Texas/the Southeast are over. This is a natural byproduct of over-supply.

Are Oz and CA paying American wages?
My pick would be PEM- that's growing, fast, and salaries are beating out EM if you can stand it.
I love @gamerEMdoc, but I agree with you. It's hard to convince an APD EM is toast, I guess. I'm still curious as to where his residents are getting these sweet gigs, because no one else can find them.

 

[deleted1027621]

I have found the same with locums. I used to work locums full time, but I finally signed a local contract full time as the rates being offered were not worth the travel time, living half time in a hotel and time away from my spouse. I looked into fellowships. Pain is quite competitive and it is still a bit of an upstream battle for a spot as an EM doc. There is also a lot of talk about decreasing reimbursements. Palliative is under assault by midlevels. I don't know what else to do. No way is EM worth it for $150/hr. I mean, a psych patient was using their full colostomy bag as a weapon last night.

 

[miacomet]

Yeah, I feel had. I enjoy the field, but I went into it against my better judgement (never pick a career where you aren't an owner or aren't close to the money stream). I'd be happy in cards, ID, or even psych, but the EM fellowships are questionable as @DaKitty noted.

 

[Fox800]

Are Oz and CA paying American wages?
My pick would be PEM- that's growing, fast, and salaries are beating out EM if you can stand it.
I love @gamerEMdoc, but I agree with you. It's hard to convince an APD EM is toast, I guess. I'm still curious as to where his residents are getting these sweet gigs, because no one else can find them.

Pretty close. Might take a 10-30% pay cut, but you're working with a much more reasonable population, basically no fear of litigation, patients with access to primary care, less coding/documentation idiocy, usually have generous CME and paid vacation, etc.

I see locums has gone from $275-300+/hr to $225 at a lot of places. Think about how much of a pay cut that is.

 

[TheSingularity]

The fellowship I want to do is a paycut, but I will trade that for more sanity and work that I care about. My wife makes enough money so that we can afford it comfortably (lucky for us).

Unfortunately, this particular field is likely being assaulted by midlevels too, which means I'll likely have to do academics, if I can even get hired. I'm actually ok with that cause I would much prefer academics at this point after taking it in the balls for a number of years in the community.

If that fails and EM truly in the can by that point , I'll do limited time in the ED (maybe 5 shifts / month) to stay fresh for (maybe eventual) turnaround of the field, and really try to reinvent myself (way harder than some people on the blogosphere make it seem).

Or maybe I'll be a full time stay at home dad and let my wife be the breadwinner. I love that work way better anyway.

Sent from my Pixel 3 using SDN mobile

 

[miacomet]

Is anyone considering a second residency? I've thought about psych....

 

[deleted1027621]

I am the sole breadwinner. I need four more years to be FI. I am starting to doubt I will get 4 more years of good pay.

I thought about a second residency. Psych has minimal overhead and the ability to do cash only practice with control over how the practice is run. No expensive equipment to buy. But three more years of residency. Oomph.

I looked at aesthetics. I just don't know if I could in good conscious convince patients that they "need" thousands of dollars of stem cells injected into their faces to be radiant and desirable. I also don't know how I feel about having to inject myself to help sell the products.

 

[Porfirio]

The problem is EM is not holding on to its identity as a specialty anymore. Mid-levels, FM docs, and IM docs all doing EM. Why pay an EM doc more when you have all these other choices? FM/IM has been hurting for years and produce way more residency graduates than EM. Mid-levels have nothing to lose, they just want to make more too.

 

[miacomet]

So, I think all of us, excepting @gamerEMdoc, are pretty much in agreement as to the problem.
I've got a few more years to FIRE, but I'd really like to do SOMETHING medical. So hard.
Don't want to totally hijack the thread, but I think we all need to brainstorm.

 

[KGflyboy]

Although I've seen pretty poor locums offers, I recently found a full time job and had no problems finding employment. The job market is in the applicant's favor in my region. I live in the middle of the country. I looked at jobs with CMGs, SDGs, and hospital employment. I interviewed at all types of jobs.

Residents where I did residency are getting recruited earlier and earlier every year. The signing bonuses are good. Every single place I contacted offered me a job. All of them.

Pay seems to be between $200-$250 for w2 work. You won't find a job on the higher end without sacrificing some sanity, but there are pretty darn good jobs to be had in the middle of that range. Is that pay reasonable in the eyes of people who have been doing this a why? I don't know. It seems acceptable to me. Cost of living is low here. You can buy a a decent 4br 3 bath house in a good suburb for < $200,000, which I did as a resident. With attending pay, you can upgrade to a nice big house on the lake and a nice car if that's your style. It's not for me, so I tend to keep more money from every paycheck.

I realize it's not like this everywhere, but in my area cities of all sizes are still hiring like crazy. You don't have to look rural to find good paying jobs. Do I think it will stay this good? Not really. I think the states in the middle are just a little slower to see the market forces created by residency expansion and mid-level expansion.

But for anybody struggling to find a good job and is willing to live far from the coast, there is hope. At least for now.

 

[deleted1027621]

To be fair, I am still recovering from making $350/hr, day light only, no holidays with frequent double time shifts with locums to being offered $220/hr to work in the same dumpster fires. The wage fall was meteoric, so the paranoia has set in to expect to see the same with my full time gig and part time job.

The job is hard. The PTSD style nightmares, the heart ache, the stress. We are expected to be perfect and miss nothing, have door to doc times of <10 minutes, dispo pts appropriately after a "full workup" with all results back in less than 2.5 hours despite inadequate nursing staffing while juggling sh** throwing patients, gently telling the guy with the gun tucked in his waistband that I can't rx more narcotics for him as he gets more irate.... ahh. You guys get it.

 

[alpinism]

You’re getting lowballed by the locums company. Worked there for a month last summer and got 125/hr with all expenses including the flight and hotel covered.

I got a phone call last week offering $90/hr for locums work in the Virgin Islands. I don't care how good the weather is, how pretty the beaches are, or how much "fun" you tell me I will have there. I'm not working for $90/hr, and anybody who does is driving down the rates for everyone who actually has common sense and avoids junk offers like that.

 

[alpinism]

If you still want I can give you the USVI medical directors personal email. They still call me every few months asking for me to cover shifts. Definitely not a cakewalk but it’s not too bad compared to many of the mainland hospitals. You’ll see some interesting pathology and tropical diseases if you enjoy those types of patients. Overall it’s fun to do for a month if you want to explore the islands but definitely not something I’d consider doing long term because of the horrible salary.

Some of my recent interactions/experiences:

• Rural hospitals in Texas 2-3 hours from a major city. Will not reimburse travel or lodging. One told me "we prefer to hire PAs/NPs", offered $89/hr, and did not cover travel or malpractice. This was literally the worst offer I've ever heard of. I then realized he was literally offering me PA/NP pay and then cannot figure out why physicians don't want to work there. Then proceeded to ask if I'd have any interest being a medical director. Texas does not have independent practice for midlevels.
• So far have only found two rural sites with any needs within 90 minutes of where I live. One paying $89/hr and one paying $120/hr.
• 2 hours from my home (with no traffic): FSED $170/hr with an "extra $10 for every disposition". I'm told it is not slow either, more like 2+PPH. The group had to scrounge the bottom of the barrel to offer me that.
• One employer interviewing in my immediate area. $200/hr. Makes you sign an exclusivity clause so you can't work anywhere else. Interviewed 200 docs and hired 7. Take it or leave it.
• USVI: $125 per hour with travel. Hospital is not a cakewalk to work at. Could not get the director to e-mail me back when enquiring about shifts as I had time off and just wanted to see the islands/pick up some work on the side.
• Denver (USACS) $145/hr with a 4-year buy in. Barf. Next.
• Portland: $200/hr to work at a dysfunctional, older ED.
• I have recently interacted with a few of the large locums groups: Weatherby, Global, Hayes. I quote then $275/hr with travel covered, $240-250 for a slow rural site (1PPH or less). I figured this is fair for the inconvenience of traveling. When I mention these numbers they disappear/ghost. They consistently offer $220/hr to work at busy places in states with bad or mediocre med-mal environments and think it's a fair deal.
• I found one place offering $285/hr at a typically busy place and $240/hr at a slow site. I think THAT is fair.

Buyer beware when it comes to EM these days.

 

[KGflyboy]

You’re getting lowballed by the locums company. Worked there for a month last summer and got 125/hr with all expenses including the flight and hotel covered.

Yeah I was offered like 2/3 of what they gave you. $125 might get me a little more interested. Something about seeing the double number vs a triple digit number just seems so much worse and immediately made me lose interest.

 

[alpinism]

The locums market has definitely gotten tighter over the past couple years. There’s still a decent number of good locums jobs available but you have to know where to look. I’m going to start working a few shifts per month this spring at a critical access hospital in Southern Colorado and will be making 175/hr for 0.75 PPH which is a pretty sweet deal all things considered.

 

[TooMuchResearch]

I've got 4-5 years minimum until all debts are paid. Won't be near FI. Womp womp.

So, I think all of us, excepting @gamerEMdoc, are pretty much in agreement as to the problem.
I've got a few more years to FIRE, but I'd really like to do SOMETHING medical. So hard.
Don't want to totally hijack the thread, but I think we all need to brainstorm.

 

[Brigade4Radiant]

More people are just doing locus they do it when they get tired of working the local CME rates. I know so many N.Y. docs and Cali docs who work next to me in the south.

 

[gamerEMdoc]

I appreciate being called out as the lone optimist, but I do have concerns as well. I just believe that salary reports dont seem to reflect what everyone here is saying, nor has my personal experience. I believe that the market is tightening in some areas, I believe you all, but I also believe that the market is also increasing in others. I understand the fall in huge hour rates dropping by 100/hr in some areas. My hourly rate has increased about 70/hr in the past 7 years. Some go up, some go down. There were jobs paying 140/hr when I graduated 10 years ago. Jobs that dont pay well arent new.

When any of my residents struggle to find a decent job, then Ill believe the market is spiraling down. It just hasnt happened. I get the skepticism about acep and cmgs but their salary reports continue to show a national rise. Ive seen a steady increase in my personal salary consistently for the past decade. So Im not being an optimist for being an optimists sake its just that national reports and personal experience seem to agree with one another in my case and in the case of my graduates. I sympethize with others whose markets decreased, and understand that isnt the case for others. I see big future concerns with too many residencies, cmgs, legislation, MLPs, etc. I definitely see a scenario where our salaries could go down across the board, no doubt. I get the concern for it falling. I could see it doing so. I just dont believe its inevitable or even the most likely scenario. Only time will tell, I dont think the future of the lucrative nature of this specialty, nor any other, is guaranteed. We shall see.

 

[ShockIndex]

I’m somewhere between @gamerEMdoc and and the apocalypse crowd. While it’s true that average salaries are still increasing, there are clear signs that the market is tightening and no reason to think the trend will reverse.

On the other hand, the amount of extraneous BS in the form of entitled patients, drug seeking, onerous regulations, non-emergent care, etc. hit critical mass for me 2 years ago.

 

[gamerEMdoc]

On the other hand, the amount of extraneous BS in the form of entitled patients, drug seeking, onerous regulations, non-emergent care, etc. hit critical mass for me 2 years ago.

Yeah this to me is the biggest downside of EM that I dont see getting better. Dealing with the rude public who wants instant care for non-emergencies but who dont want to pay for it. Combined with the stifling bundles, metrics, and regulations. This is the stuff that Im not an optimist about.

 

[TysonCook]

I would further delineate these scenarios impacting different subgroups of EM and not be lumped together. I see it as: Employed versus CMG versus SDG being different. If you aren't in a SDG then someone else has fingers are in the till, and driving the car. When you are not in control of any aspect of your job, then options are bleak. I'll also posit that SDG aren't exceptionally viable unless it's a big group (BDG?) that is difficult to replace (100-200+ docs). If currently in a SDG, I'd be looking at other local ED SDG's to band together.

 

[TheSingularity]

Ya and before you know it you can get some VC buy in and become another CMG!

I would further delineate these scenarios impacting different subgroups of EM and not be lumped together. I see it as: Employed versus CMG versus SDG being different. If you aren't in a SDG then someone else has fingers are in the till, and driving the car. When you are not in control of any aspect of your job, then options are bleak. I'll also posit that SDG aren't exceptionally viable unless it's a big group (BDG?) that is difficult to replace (100-200+ docs). If currently in a SDG, I'd be looking at other local ED SDG's to band together.

Sent from my Pixel 3 using SDN mobile

 

[deleted859535]

A counterpoint to the always pessimistic, "EM is done" posters lately, for the med students and residents here:

EM is not done. Some people have it better than others and thus see it differently than others. Some work in worse environments and will tend to see things in a dimmer light. Some people are better in tune with regional and national potential changes that would affect us in the near future. Some people just think they are and are overly pessimistic/optimistic.

It's an online forum.

Ultimately, nobody knows to what degree things will change.

Some markets are ****. Some are not. Old problem.

Other specialties have lots of problems, too. Some problems affecting us also affect them. Some don't and are unfortunately exclusive to us. Some are exclusive to them and don't involve us.

Will my income in 2025 or 2030 be less than what my 2019 was? Yeah, probably, though neither I nor you nor anyone else knows if it'll be a significant difference versus the work at the time. My favorite general surgeon may or may not have the same problem. Nobody wants to work as hard as we (and most other specialties) do, for the same liability, after the same sacrifices, but for less financial security. But to say the whole of the specialty is crashing is a bit much.

I don't really know if I would pick EM again or if I would go to med school again, and I share the same concerns about government meddling and balance billing and insurance reimbursement cut scheming and all the rest, but regardless, at least take what you read with a grain of salt.

 

[stickflip723]

.

 

[deleted941485]

Would someone mind explaining to a clueless and concerned medical student about this idea of not having your own patients leaving you more vulnerable to decreasing compensation? I'm very interested in EM but sometimes the negativity on this forum is too much to look at.

What they don’t tell you in medical school is that there are upstream referring doctors (IM, FM, peds, OB) who can control the flow of patients and downstream docs who depend on referrals (rads, surg, Rad Onc, EM, path). If you have control over the flow of patients and patients know and trust you, then it gives you more leverage.

EM has little to no control over patient flow. The patient shows up triaged and needing an evaluation. There’s not much relationship building going on. ERs are busy, chaotic, and dangerous places. Patients are pissed off and usually have been waiting for quite some time.

 

[stickflip723]

In a nutshell it’s this: If my hospital fires me tomorrow, exactly zero patients will know or care. They’ll just see whoever was hired in my place. On the other hand if a beloved cardiologist is shoved out the door, 1000 patients may get real upset that THEIR cardiologist was let go and take their business across town. Or said cardiologist may even be in private practice rather than a hospital employee, and have no one who’s able to shove them out the door in the first place.

What they don’t tell you in medical school is that there are upstream referring doctors (IM, FM, peds, OB) who can control the flow of patients and downstream docs who depend on referrals (rads, surg, Rad Onc, EM, path). If you have control over the flow of patients and patients know and trust you, then it gives you more leverage.

EM has little to no control over patient flow. The patient shows up triaged and needing an evaluation. There’s not much relationship building going on. ERs are busy, chaotic, and dangerous places. Patients are pissed off and usually have been waiting for quite some time.

Interesting, thank you both.

 

[Fox800]

If you still want I can give you the USVI medical directors personal email. They still call me every few months asking for me to cover shifts. Definitely not a cakewalk but it’s not too bad compared to many of the mainland hospitals. You’ll see some interesting pathology and tropical diseases if you enjoy those types of patients. Overall it’s fun to do for a month if you want to explore the islands but definitely not something I’d consider doing long term because of the horrible salary.

Appreciate it. I actually have their contact info, they’re just being unresponsive for some reason.

 

[ShockIndex]

Would someone mind explaining to a clueless and concerned medical student about this idea of not having your own patients leaving you more vulnerable to decreasing compensation? I'm very interested in EM but sometimes the negativity on this forum is too much to look at.

The explanations given by @Mr. Hat and @RadsWFA1900 are outstanding. Particularly important is the lack of relationship building. This causes a very transactional experience with many patients who show-up with an agenda and treat EPs like a cashier at Walmart. The interaction with some consultants (not a majority) is sometimes similarly transactional - especially when calling about consults who are not their private patients.

 

[YCAGA]

So for the med students out there interested in the aforementioned “doomed specialities” (EM and anesthesia for me), what specialities are NOT doomed? Surgery? Primary care?

Also, is ACEP just propaganda? Their salary numbers this year still seem high and the number of FM/IM doctors working in EDs is shocking (>40% in many states). I scribed in the ED full-time for a year before med school and I definitely saw the...striking difference between FM/IM trained doctors and EM trained doctors. I guess that doesn’t matter if the public is naive and FM/IM is way cheaper?

I really loved my time in the ED but this website makes me already hesitant about choosing medicine