Private Practice in Emergency Medicine

[Roy7]

Here's my dilemma:

I've got no loans, no debt, and a good amount of savings (scholarship), and my entire family/social circle is highly involved in business (more the accounting side). I had previously hoped to open a private practice after completing a medical specialty and using my saved money and all the resources that i've got available to help make the practice thrive and subsequently have the possibility to do very well financially.

But lately i've found myself really drawn to emergency medicine - but from what I've seen in my very very limited experience (MS1), most emergency medical specialists work in a hospital and are salaried.

Now, if I went into EM, would I be cutting off the possibility to make more financially? Would I be throwing away the business resources available? Or are there any options for privatization in EM that would have the potential to also do very well financially?

Now, before I get flamed for being greedy - I'm going to admit that yes I would like to make as much money as I possibly can - but, the appeal of medicine is that I would have the opportunity to save lives while doing so.

I'm not in medicine for the money, but I want to make the most I can with what i've got.

Lastly, if I get flamed for being and MS1, well, I'm just curious and want to see what options are out there. I've got the personality type that whatever I end up doing I'll probably like doing as long as I end up saving some lives and making ends meat.

Thanks in advance

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[Law2Doc]

Here's my dilemma:

I've got no loans, no debt, and a good amount of savings (scholarship), and my entire family/social circle is highly involved in business (more the accounting side). I had previously hoped to open a private practice after completing a medical specialty and using my saved money and all the resources that i've got available to help make the practice thrive and subsequently have the possibility to do very well financially.

But lately i've found myself really drawn to emergency medicine - but from what I've seen in my very very limited experience (MS1), most emergency medical specialists work in a hospital and are salaried.

Now, if I went into EM, would I be cutting off the possibility to make more financially? Would I be throwing away the business resources available? Or are there any options for privatization in EM that would have the potential to also do very well financially?

Now, before I get flamed for being greedy - I'm going to admit that yes I would like to make as much money as I possibly can - but, the appeal of medicine is that I would have the opportunity to save lives while doing so.

I'm not in medicine for the money, but I want to make the most I can with what i've got.

Lastly, if I get flamed for being and MS1, well, I'm just curious and want to see what options are out there. I've got the personality type that whatever I end up doing I'll probably like doing as long as I end up saving some lives and making ends meat.

Thanks in advance

I think there is probably opportunity for emergency docs to be private. I've worked in an ED where the physicians were part of a group practice and not actually salaried directly by the hospital. I have no idea how this worked though, or whether their salary was any different than had they worked directly for the hospital. Perhaps someone else on here knows more.

 

[JohnUC33]

I currently work at a hospital in a rural area. Many of the E.R. doctors who work here also have their own practices. Our hospital uses a physician contractor for the E.R. The doctors work through this contractor and the contractor tells them what hospital to go on a certain day (most doctors actually tell the contractor when or when not they will work). Yea, you can do both. If I do primary care, then I will definately work in an E.R. on the side.

 

[Hoya11]

Open your own urgent care place, but you only need FP or IM for that, EM works too though, but you get paid less for urgent care than Er work, but maybe not if you own the urgent care place.

 

[stargirl50]

I currently work at a hospital in a rural area. Many of the E.R. doctors who work here also have their own practices. Our hospital uses a physician contractor for the E.R. The doctors work through this contractor and the contractor tells them what hospital to go on a certain day (most doctors actually tell the contractor when or when not they will work). Yea, you can do both. If I do primary care, then I will definately work in an E.R. on the side.

You won't necessarily be jumping around to different hospitals if you take this route either-- it's possible for you to work for one of these contractors and work at a single hospital. Or, if youre savvy enough, you can contract yourself out to an ED--skip the middle man-- and be technically self-employed. However, in my experience (which comes from family) both of these situations are getting harder to come by. Good luck!

 

[Roy7]

That's great! If anyone knows where I can get some information about contractors or companies in which EM's are contracted out that'd be great. i'd love to find out more.

Thanks.

 

[Mike MacKinnon]

hey

Where I live there are Stand Alone ER's run by an ER physician (or a group). These ER's are a catch 22 however. You end up with on site lab, ct and such, but there are no in patient beds and they quickly get overwhelmed and therefore, profit stops if the transfers do.

I dont know what I think about them yet. They are too new here to know for sure but unless local hospitals increase in-patient beds, i dont see how the stand alone ER will thrive either.

(and No these are not urgent care centers, they are staffed by physicians boarded in EM ONLY).

 

[sscooterguy]

hey

Where I live there are Stand Alone ER's run by an ER physician (or a group). These ER's are a catch 22 however. You end up with on site lab, ct and such, but there are no in patient beds and they quickly get overwhelmed and therefore, profit stops if the transfers do.

I dont know what I think about them yet. They are too new here to know for sure but unless local hospitals increase in-patient beds, i dont see how the stand alone ER will thrive either.

(and No these are not urgent care centers, they are staffed by physicians boarded in EM ONLY).

My girlfriend is interviewing for EM right now in the midwest and east coast. Private groups are the big thing. They make tons of money, and I don't know how everyone thinks EM physicans can't make money. The attendings at my school and from programs that my girlfriend is interviewing are saying that by working 3-4 12 hour shifts a week, you can make $215-250k after you get about 2-3 years of experience after residency. Now I don't know about you, but getting that much money for 3-4 days a week is one of the sweetest deal I've found. Many EM's supplement their income with private urgent care practices. However, many also enjoy their time off.

sscooterguy

 

[Law2Doc]

My girlfriend is interviewing for EM right now in the midwest and east coast. Private groups are the big thing. They make tons of money, and I don't know how everyone thinks EM physicans can't make money. The attendings at my school and from programs that my girlfriend is interviewing are saying that by working 3-4 12 hour shifts a week, you can make $215-250k after you get about 2-3 years of experience after residency. Now I don't know about you, but getting that much money for 3-4 days a week is one of the sweetest deal I've found. Many EM's supplement their income with private urgent care practices. However, many also enjoy their time off.

sscooterguy

The salary per hour you describe is certainly nice (although I question whether folks are really limiting to a 36- 48 hour work week - sounds unlikely) , but I suspect until you get really senior, the hours you have to work aren't the daylight ones. If not, I wonder whether 4 overnight shifts per week still sounds like such a good idea while you get into your 30s and beyond.

 

[DropkickMurphy]

*shudders* FP docs in the ER (outside of fast track of course) are not a good idea IMHO. It should be like any other specialty- either you are have done a residency or you don't get to play ball in that given specialty. Every ER I have seen where primary care docs run the show are great when the minor emergencies and general care things are involved but when the **** hits the fan the patients are the ones who suffer.

 

[DropkickMurphy]

The salary per hour you describe is certainly nice (although I question whether folks are really limiting to a 36- 48 hour work week - sounds unlikely) , but I suspect until you get really senior, the hours you have to work aren't the daylight ones. If not, I wonder whether 4 overnight shifts per week still sounds like such a good idea while you get into your 30s and beyond.

folks are really limiting to a 36- 48 hour work week

Ask this in the EM forum....It is very close to the truth in many cases.

 

[rxfudd]

Private EM groups are pretty much the standard nowadays. You can work as an independent contractor, but it often amounts to moonlighting (and there is no ability to become a partner since you are not part of a group, so you won't get all of the financial benefits that come with that).

EM is generally paid at an hourly rate, with low end salaries being about $100/hour and high end being about $150-180/hour. Remember, there are lots of different ways to get paid, and sometimes a lower hourly salary with an awesome benefits package and/or pension can be more competitive than anything else on the market. This generally works out to $200K-$270K per year before taxes, with some extreme salaries on either end (I've heard of academic positions at $150K and middle-of-nowhere ones at $350K). Typically, people work between 36-48 hours weekly. Some younger docs work a bit more to make some more money, or they spend their free time moonlighting at smaller, single coverage ERs (i.e. being the only MD or DO in the ER, and sometimes one of only a few in the building if it's late at night). It is not uncommon at all to see people working 3 twelves or 4 eights/tens each week. I've even heard of some EPs who do the single coverage thing and work two 24 hour shifts a week. This gives you 48 hours a week (typically at a higher salary, since single coverage sucks) and 5 days per week off. Another interesting variation is to do exhaustive hours (60 or so per week) for 7-8 months and take 4-5 months of the year off. The possibilities are only limited by what the people in your group are willing to accomodate.

As for the shifts you get, there is no doubt that you get crappier shifts as a young attending. Out of 12-16 shifts per month, my observation has been that most first year attendings work about 8 of them during the night. However, after a year or two you are just like any other attending in the practice. Most senior people in the group tend to do late nights only if they want them.

In all of this, just remember that 8 hours in the ER feels like 16 hours anywhere else. One a medicine service, you might be on call for 30 hours straight, but a good number are spent on downtime (checking email, getting a couple hours sleep, talking to people, rounding, etc - it adds up). There is very, very little downtime in the ER, so it can feel like an entire call condensed into one 8-10 hour period. This particularly sucks if you do 12 hour shifts. Still, most would rather work this way and get 15 days off each month.

 

[Supercluster]

Not much to add other than the fact that I attended a lecture by an EM doc a little while ago and it seems like the private practices are getting big here too. I was surprised because I really hadn't realized that there were other opportunities outside of being a hospital employee. The pay in Buffalo isn't quite as sweet as some of the numbers I've seen quoted, but definitely around $200K (which goes VERY far in this area-->low cost of living). The issue that I personally have (and I am interested in pursuing EM) is that the private practice doctors rarely get to teach and I really like teaching, so I'm not sure if I'd like that. I just don't know if I'd want to be in a non-teaching hospital.
However they do get paid more 😉