Salary and FP

[digitlnoize]

Our Western population tends to value athletic prowess, which adds very little if anything to society, over intelligence. I have no idea why.

This is one reason why the general individual takes issue with a doctor making a lot of money, yet is ok with A-Rod raking in millions to catch a ball.

I fault the surgeons for not turning surgery into a spectator sport long ago.

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[deleted87716]

I fault the surgeons for not turning surgery into a spectator sport long ago.

It used to be.

Blame television.

 

[JackADeli]

...Blame television...

Ahhhhhh, the good old days of the operative theatre. You can now blame HIPAA too.

On slightly different note... I was speaking to some of my friends in FP residency. So, she tells me she is PGY2 and doing some moonlighting. She does 3-4 weekend shifts a month and makes $150-180K/yr just from the moonlighting gig. She is quite excited about her income prospects when she actually is an attending. She anticipates large incomes between a practice and the revenues she can make on the side, though, not sure if those opportunities will continue with new healthcare reforms...

 

[JaggerPlate]

It used to be.

Blame television.

This is how people get junior mints stuck in their abdomen.

 

[deleted87716]

This is how people get junior mints stuck in their abdomen.

"Who's gonna turn down a Junior Mint? It's chocolate, it's peppermint, it's delicious!"

 

[wake5233]

She anticipates large incomes between a practice and the revenues she can make on the side, though, not sure if those opportunities will continue with new healthcare reforms...

Why do you think these opportunities will dry up? It seems like that with a huge increase in demand there would be even more opportunity?

 

[JackADeli]

Why do you think these opportunities will dry up? It seems like that with a huge increase in demand there would be even more opportunity?

It will all depend on what the revenue streams look like. Will there still be need for moonlighting shifts? I suspect yes. Will the hospital revenues support current moonlighting payment levels? I don't know.

 

[cali-ob]

Ahhhhhh, the good old days of the operative theatre. You can now blame HIPAA too.

On slightly different note... I was speaking to some of my friends in FP residency. So, she tells me she is PGY2 and doing some moonlighting. She does 3-4 weekend shifts a month and makes $150-180K/yr just from the moonlighting gig. She is quite excited about her income prospects when she actually is an attending. She anticipates large incomes between a practice and the revenues she can make on the side, though, not sure if those opportunities will continue with new healthcare reforms...

Wait, she is making 150K just from moonlighting??? by 3-4 weekend shifts, do you mean basically working every weekend, Sun and Sat or 3-4 weekend shifts meaning 3-4 weekend days/month? I am obviously working at the wrong place. If I work 3-4 shifts per month I will double my resident salary and a little more but not triple it! wow!

 

[JackADeli]

Wait, she is making 150K just from moonlighting??? by 3-4 weekend shifts, do you mean basically working every weekend, Sun and Sat or 3-4 weekend shifts meaning 3-4 weekend days/month? I am obviously working at the wrong place. If I work 3-4 shifts per month I will double my resident salary and a little more but not triple it! wow!

I don't know exactly what the weekends of moonlighting entail... I just know she is banking alot. She could just do the moonlighting and make a bundle and have the entire week otherwise free. As a resident, I think ~$35/yr, she is banking huge with that moonlighting, almost $200+k/yr. She has lots of fancy things.

 

[Life101]

I don't know exactly what the weekends of moonlighting entail... I just know she is banking alot. She could just do the moonlighting and make a bundle and have the entire week otherwise free. As a resident, I think ~$35/yr, she is banking huge with that moonlighting, almost $200+k/yr. She has lots of fancy things.

Is she doing inpatient or outpatient moonlighting? Urgent care clinics, ED?

 

[JackADeli]

Is she doing inpatient or outpatient moonlighting? Urgent care clinics, ED?

She's doing ER shifts, she was initially doing outpt/clinic shifts with a FP doctor that was doing some cosmetics in the office. But, now she does just the ER shifts.

 

[AFSmiley]

Seems like Urgent Care is a good way to make some monies between residency and establishing your own practice or finding some group to latch onto.


It's good money, it leaves you a lot of time for the job search, or golf, or studentdoctor.net-ing.....

I think with the current reforms- hospitals will win. More insured people = less charity care = less charity cases coming through the ED.

That is all. Carry on,

~Smiley.

 

[JackADeli]

...More insured people = less charity care = less charity cases coming through the ED...

Maybe... but the uninsured are not the majority flooding the ER.
Maybe, more "insured" will mean more "insured" going through the ERs..... problem not solved.

 

[JaggerPlate]

Just to be clear ... 150k from moonlighting is not standard??? Correct???

 

[JackADeli]

Just to be clear ... 150k from moonlighting is not standard??? Correct???

I don't know that statement to be true. I will leave it to the other FP/FM residents to comment.

ALL the FP/FM residents I speak with make upwards of $150K/yr moonlighting. It comes down to how much additional work the resident wants to do and how much free time they want to use for it. It also comes down to how comfortable the resident feels assuming the role of "attending" in an ER or imaging center or urgent care center, etc.... But, the amount it moonlighting seems mostly dependent on the individual.... Oh, and some have to do it in secret cause I think some programs have rules limiting moonlighting. So it is more often the individual or the program and not the opportunities that limit moonlighting.

 

[deleted87716]

$150,000 seems high, especially given the limited time available during residency for moonlighting. The biggest moonlighters in residency when I was a resident made around $40,000 extra per year by moonlighting. However, they had no life. We could only moonlight during second and third year.

That being said, not all of our moonlighting opportunities paid the same, and there were several residents who wanted to moonlight, so you had to divvy it up.

I suppose if some place had a particularly lucrative opportunity and nobody else was interested in doing it, an individual resident could clean up.

 

[digitlnoize]

$150,000 seems high, especially given the limited time available during residency for moonlighting. The biggest moonlighters in residency when I was a resident made around $40,000 extra per year by moonlighting. However, they had no life. We could only moonlight during second and third year.

That being said, not all of our moonlighting opportunities paid the same, and there were several residents who wanted to moonlight, so you had to divvy it up.

I suppose if some place had a particularly lucrative opportunity and nobody else was interested in doing it, an individual resident could clean up.

Seems pretty high to me. An extra 150k means that she would need to work 24 hrs extra every week at 120/hr. Possible...I guess, but not fun or sustainable.

 

[JackADeli]

...not all of our moonlighting opportunities paid the same, and there were several residents who wanted to moonlight, so you had to divvy it up.

I suppose if some place had a particularly lucrative opportunity and nobody else was interested in doing it, an individual resident could clean up.

...An extra 150k means that she would need to work 24 hrs extra every week at 120/hr. Possible...not ...sustainable.

Actually, quite sustainable. Practicing physicians put in those hours regularly in other specialties on a sustained basis. I don't see FP/FM residents any less capable of work then other fields. Also, weekend shifts 12 hours or 24 hr shifts are apparently what she does... and the others I have spoken with about this. They apparently contract with some companies hiring to staff areas of need. Again, I would add the work limiting factors are twofold:

1. How much a resident is willing to work
2. Does their program restrict them and/or are they going over and above what their program allows.

I know some places where programs have only a single moonlighting situation in immediate vicinity and all the residents split it as BD suggests. Some of these have been staffing imaging centers in event of anaphylaxis/etc... that does not mean there are not other opportunities being over looked. The overlooked opportunities seem to be the lucrative/unchallenged ones. Most new residents are told what moonlighting has been done previously... which is the easiest path but not necessarily the only path or most lucrative path. To make bank, you need to think outside of your individual program's box.

As per sustainability, I want to put it into some perspective.... More often then not, my friends in FP/FM work less then 65 hours per week. My friends in surgical specialties routinely work in excess of 80hrs per week. Numerous surgical attendings and other specialty attendings work in excess of 85 hrs/wk. Again, I don't see FP/FM residents so weak as to be incapable of the work.

 

[AFSmiley]

Maybe... but the uninsured are not the majority flooding the ER.
Maybe, more "insured" will mean more "insured" going through the ERs..... problem not solved.

I wasn't saying anything was solved I was just saying that I really think the hospitals were the big winners with this healthcare legislation.

Thes less charity cases they have to deal with the better off they are.

 

[JackADeli]

I wasn't saying anything was solved I was just saying that I really think the hospitals were the big winners with this healthcare legislation.

Thes less charity cases they have to deal with the better off they are.

I get what you are saying.... but my point is that the ED/ER volume problem really has NOT been one of charity/uninsured care... though you wouldn't know that from the political pundits.

As for the hospital being "winners".... not sure on that either if more and more of their "insured" population is rolled into medicare/medicaid esque type reimbursements.

 

[avatarftw]

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[doc20]

working a urgent care/ed shift of 12 hours is completely different then 12 hour wards or clinic duty. you see lot more patients and need to make lot more diagnosis ...
yeah a lot of residents like to exaggerate, but the upper limit is to basically double resident salary to 110-120 gross total... no resident can make extra 150 k plus 47 in resident salary that is just impossible

 

[JackADeli]

...no resident can make extra 150 k plus 47 in resident salary that is just impossible

If you say so...NOT. Yes, plenty of folks continue to argue how "different" it is and impossible it is from one specialty to the next... You are correct, it is always impossible for those that have that mindset. Just a rhetorical question, who do you think works 12 & 24 hour shifts... in ED/ERs & other practices???

Those that put their nose to the grindstone and put in the hours do make the cash. I have watched my friends & colleagues pull down $30k per two months in moonlighting. It is not impossible... because it is being done. I can't speak to where you practice. I see no need to argue further on the subject. I just know it is done and done successfully in other areas.

Regards

 

[MedicineDoc]

At Trover (western kentucky regional medical center) in madisonville, ky we moonlight 60 hours per month (everyone is usually maxed out except the females who generally want to moonlight less) during fall and winter and variable amounts during the spring and summer. The institution provides the malpractice. Our base salary or stipend (whatever you want to call it) is 50,000 plus whatever moonlighting hours. It's 65 dollars an hour for the urgent care (down the hall from the resident clinic) and 100 dollars an hour in the ER. We do call from home. I think one of our old residents used to get way up there in terms of salaries but that was before the program got dinged once for someone doing over 60 hours per month. The typical weekday shift for our urgent care center is from 5 pm to 8:30 pm with getting paid for a 5-9 pm. The weekend care center shift is 8 am to 8 pm on Saturday and 10 am to 6 pm on Sunday CST. The ER shifts are typically 12 hours on the weekend. There is generally plenty of weekends off and sometimes all of them off except on certain rotations. One of our residents who is about to graduate has done alot of moonlighting in our ER and is going to work there when he graduates in July. The good thing about moonlighting is you can learn and get paid at the same time and it helps to make you faster. Alot of times if they need a doctor and have something that may need more than a care center visit I refer them to myself and see them in the FP clinic. Another recent grad is working on the hospitalist service at our hospital. Our ICU is about 25 beds and about 400 beds on the floors. We have everything but neurosurgery. It is an unopposed program.

 

[cabinbuilder]

$150,000 seems high, especially given the limited time available during residency for moonlighting. The biggest moonlighters in residency when I was a resident made around $40,000 extra per year by moonlighting. However, they had no life. We could only moonlight during second and third year.

That being said, not all of our moonlighting opportunities paid the same, and there were several residents who wanted to moonlight, so you had to divvy it up.

I suppose if some place had a particularly lucrative opportunity and nobody else was interested in doing it, an individual resident could clean up.

So I just did my taxes. I moonlighted an extra 8 hours a week last year during residency. Seems my base salary was 47,000 and I pull down close to $100,000 overall for the year. Not too bad for not working that hard.

 

[JackADeli]

So I just did my taxes. I moonlighted an extra 8 hours a week last year during residency. Seems my base salary was 47,000 and I pull down close to $100,000 overall for the year. Not too bad for not working that hard.

So, in simple math terms with rounding... your extra 8hrs/wk or 32hrs/month got you an additional ~$60K. So, in your situation/location/etc... not taking into account your PDs limits/etc, one could conceivably pull down an additional ~$120K by doing 16 hours more per week. If your training program is a predominantly 60hrs/wk program, you end up working 76hrs/wk.... still well below what other subspecialty trainees and attendings work.

As others (BD, MedicineDoc, CabinBuilder) have noted, each area/program has different opportunities. The key ingredients are
1. what is your baseline residency workload/structure,
2. level of work one is willing to do over and above residency,
3. What restrictions are there limiting your moonlighting.

Long and short, while some medical students may believe it is impossible to moonlight for an additional 150-180K, it is actually possible and is done.

 

[deleted87716]

So, in simple math terms with rounding... your extra 8hrs/wk or 32hrs/month got you an additional ~$60K.

~$50K, actually...and that's rounding up.

If he moonlighted for 8 hours/wk. 48 weeks out of the year, he'd have to be earning $130/hour moonlighting in order to hit $50,000. Is that typical nowadays?

 

[JackADeli]

...he'd have to be earning $130/hour moonlighting in order to hit $50,000. Is that typical nowadays?

I am hearing 120-130 depending on the area and ED/ER and contract specifics. I guess some areas its is less:

At Trover (western kentucky regional medical center) in madisonville, ky ...It's 65 dollars an hour for the urgent care (down the hall from the resident clinic) and 100 dollars an hour in the ER...

I have a feeling if you get your arrangement through your residency it is less. Everyone I know getting the lucrative deals make their arrangements outside of the "regular" program deals.

 

[MedicineDoc]

I am hearing 120-130 depending on the area and ED/ER and contract specifics. I guess some areas its is less:I have a feeling if you get your arrangement through your residency it is less. Everyone I know getting the lucrative deals make their arrangements outside of the "regular" program deals.

The advantage to our setup is you have all kinds of backup if needed. You have the Er for urgent care center visits that may need admission. You have the same specialists on call for the Er available as possible telephone backup in the care center. In the Er you have Er attendings working with you. Backup isn't needed much but at times it helps the right thing happen for the patient.

 

[JackADeli]

The advantage to our setup is you have all kinds of backup if needed. ...Backup isn't needed much but at times it helps the right thing happen for the patient.

I am not speaking to the merits of one place over the other. I was simply pointing out that there are quite a few different opporunity structures out there... often overlooked by residents as they simply go with their programs flow. I think the more lucrative oportunities require more independent performance. Not all trainees are competent or comfortable enough for that level of practice.

I am a firm believer in having back-up, especially at the resident level. Back-up often = education resource. Your programs structure sounds like a nice set-up from the perspective of "graduated responsibility". It seems to allow a trainee to progress to part time attending to eventual independent attending.

 

[EdibleEgg]

It is possible.... but it's really unlikely. To pull in an extra 100K, you would really have to find an exceptional position and really bust your hump. I also don't think you are being realistic about the work hours of FM residents or subspeciality trainees (don't they follow work hour restrictions too?). I'm sure there are FM lite programs out there that work forty hour weeks, but those programs don't produce residents that will be comfortable flying solo in the ER (the only place that's going to be pay that kind of money). During my residency, we had 2-3 months per year of subspecialty rotations and electives. If you were able to schedule it you could put in an extra 80-100 hours during those months. Most moonlighting jobs at that time (2006/7) in the area (southeast) paid between 75 and 125$ per hour depending on malpractice coverage, etc. Residents that really worked hard pulled in somewhere between 40-60K in addition to base salary.

So, in simple math terms with rounding... your extra 8hrs/wk or 32hrs/month got you an additional ~$60K. So, in your situation/location/etc... not taking into account your PDs limits/etc, one could conceivably pull down an additional ~$120K by doing 16 hours more per week. If your training program is a predominantly 60hrs/wk program, you end up working 76hrs/wk.... still well below what other subspecialty trainees and attendings work.

As others (BD, MedicineDoc, CabinBuilder) have noted, each area/program has different opportunities. The key ingredients are
1. what is your baseline residency workload/structure,
2. level of work one is willing to do over and above residency,
3. What restrictions are there limiting your moonlighting.

Long and short, while some medical students may believe it is impossible to moonlight for an additional 150-180K, it is actually possible and is done.

 

[JackADeli]

...have to...really bust your hump...

...I also don't think you are being realistic about the work hours of FM residents or subspeciality trainees (don't they follow work hour restrictions too?). I'm sure there are FM lite programs out there that work forty hour weeks...

GSurgery, most programs accross the country work on average above 80hrs/wk. I recall my program... recent grad. I worked minimum 85hrs/wk and still did actually have a reasonable life. We sustained that workload for over five years in many cases. Yes, the acgme regs say average 80hrs/wk averaged over 4 wks and that is what most residents logged on paper.

So, yes, I do think FP residents could if they chose to, work upwards of 80hrs/wk. Most FP programs I know work around 60hrs/wk.... I don't know any 40hrs/wk programs.

 

[EdibleEgg]

GSurgery, most programs accross the country work on average above 80hrs/wk. I recall my program... recent grad. I worked minimum 85hrs/wk and still did actually have a reasonable life. We sustained that workload for over five years in many cases. Yes, the acgme regs say average 80hrs/wk averaged over 4 wks and that is what most residents logged on paper.

So, yes, I do think FP residents could if they chose to, work upwards of 80hrs/wk. Most FP programs I know work around 60hrs/wk.... I don't know any 40hrs/wk programs.

I'm not trying to start a pi$$ing match here, so if it sounds that way please forgive me. I know GS residents work very hard, I've done enough GS rotations to be absolutely sure of it. I'm not at all trying to compare the two. However, lots of FM residents work very hard too, and both fall under work hour restrictions. There are always exceptions to the rule, but the kind of program that works fewer hours doesn't produce the kind of resident that can run an ER alone and pull in the kind of money you mention. I'm not doubting that someone has done it, but it's very rare.

 

[JackADeli]

...I'm sure there are FM lite programs out there that work forty hour weeks...
...moonlighting jobs at that time (2006/7) in the area (southeast) paid between 75 and 125$ per hour...

...I know GS residents work very hard...
...lots of FM residents work very hard too, and both fall under work hour restrictions...

First, I am NOT saying FP/FM residents do not work hard. Second, I understand the work hours restrictions. If they haven't changed, it is 80hrs/wk averaged over 4 weeks.

That said, you suggest a "lite program (sic)" is 40hrs/wk. I agree that would be quite light. I have never heard of such a program. However, most of the FP/FM residencies I have known or had friends/colleagues in have had workloads of around 60hrs/wk (particularly starting PGY2).

So, back to my point, a FP/FM could (as many I know have) moonlight an additional 20+hrs/wk. It is not only concievable, it is maintainable AND still be at or under 80hrs/wk. Thus my point about other specialties. It is not to say FP/FM does not work hard. It is to say that 80-85hrs/wk is doable, maintanable, and can still have a life.... just different from a 60hrs/wk life. The math is simple and fairly academic.

Of course, the wrench would be if your PD knew and/or allowed you to moonlight at that level.

 

[EdibleEgg]

I don't know of any 40 hour a week residencies either. Didn't mean to give that impression. I was just speaking hypothetically. Again, I'm not saying it's impossible, just nearly impossible to make that kind of cash. Sure, FM residents are capable of working 80 hour weeks. Sure there are jobs that pay well enough to clear 150 working 20 to 25 hours per week. It just that finding a job that pays that well is tough. Finding a program that's going to let you work that much is tough. And coordinating call etc with available shifts is tough.

 

[JackADeli]

...FM residents are capable of working 80 hour weeks...

Agreed

...Sure there are jobs that pay well enough to clear 150 working 20 to 25 hours per week...

Agreed

...Finding a program that's going to let you work that much is tough...

Agreed

...coordinating call etc with available shifts is tough.

Maybe.... location/program specific.

Actually finding the work, depending on the region of the nation you train... not too hard, caveat that you think outside the box and actually look beyond the experience/tradition/information of current/previous residents.

 

[EdibleEgg]

I'll take it. That's close enough to agreement for me.

 

[JackADeli]

I'll take it. That's close enough to agreement for me.

One key point everyone interested in lucrative moonlighting must keep in mind.... you need to have a FULL/Unrestricted license. In numerous areas of the country this is not possible until after you have completed 2yrs of residency. Thus, when thinking about FP/FM, moonlighting is usually only for PGY3/Chief residents & attendings

 

[MedicineDoc]

One key point everyone interested in lucrative moonlighting must keep in mind.... you need to have a FULL/Unrestricted license. In numerous areas of the country this is not possible until after you have completed 2yrs of residency. Thus, when thinking about FP/FM, moonlighting is usually only for PGY3/Chief residents & attendings

We start as soon as we hit 2nd year.

 

[JackADeli]

We start as soon as we hit 2nd year.

Hence my wording:

... lucrative moonlighting ...is usually...