Salary - Critical Care Intensivist Vs EM physician

[decgra]

Forgive my medical student ignorance, but 2018 compensation report showed these as almost the same.

Is there no monetary motivation for EM residents to obtain a Critical care fellowship at all then?

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[BoardingDoc]

Forgive my medical student ignorance, but 2018 compensation report showed these as almost the same.

Is there no monetary motivation for EM residents to obtain a Critical care fellowship at all then?

There is no monetary motivation for an EM resident to pursue any fellowship.

Edit: except maybe pain medicine

 

[decgra]

But would an EM graduate with a fellowship, get more job opportunities?

 

[southerndoc]

But would an EM graduate with a fellowship, get more job opportunities?

In academics, yes it can open more doors.

 

[KGflyboy]

But would an EM graduate with a fellowship, get more job opportunities?

Not really. The exception is if you want an academic appointment.

 

[deleted547339]

But would an EM graduate with a fellowship, get more job opportunities?

I did the fellowship. Not for monetary reasons. It makes you more valuable to academic EM departments (as do essentially all fellowship programs), but it doesn’t necessarily make you create more revenue - therefore you won’t get paid more. It technically doubles your job opportunities as you can be an EP or intensivist, but you’d have to give up one. If you want to practice both, it makes it much, much harder to find a job - you need a place big enough to be able to move around faculty to give you a 1/2 FTE EM job and 1/2 FTE ICU job.

That being said, I think if I wanted to do purely academic EM, having the CCM fellowship would likely open most doors. It’s certainly the most rigorous fellowship off of EM, adds a lot to what you can teach residents (or at least gives you the credibility) and is viewed very positively.

 

[AlmostAnMD]

Important questions to ask yourself if considering CC from EM

"Do I make too much money?"

"Do I have too much free time?"

 

[Groove]

I'm not aware of any fellowship that pays better than bread and butter EM shifts. I doubt that I could make more than I make now though I'm sure my stress level might be lower.

I think the primary advantage is in academics and although there's aspects of academics that are attractive to me...I could never take that kind of pay cut.

 

[decgra]

Important questions to ask yourself if considering CC from EM

"Do I make too much money?"

"Do I have too much free time?"

Just wondering what you meant by the latter. CC intensivist has to do way more shifts than EM physician to earn the same money?

 

[decgra]

I'm not aware of any fellowship that pays better than bread and butter EM shifts. I doubt that I could make more than I make now though I'm sure my stress level might be lower.

I think the primary advantage is in academics and although there's aspects of academics that are attractive to me...I could never take that kind of pay cut.

Mind if I ask what an average difference in pay scale is between an Academic and Community EM physician?

 

[Dr Mantis Toboggan]

Just wondering what you meant by the latter. CC intensivist has to do way more shifts than EM physician to earn the same money?

Yes. My buddy did EM/CC and is in the unit this week. He’s worked about 70-80 hours this week. I’ll work 130 for the whole month.

 

[Mad Jack]

There is no monetary motivation for an EM resident to pursue any fellowship.

Edit: except maybe pain medicine

Pain will often result in a pay cut these days from what I hear

 

[alpinism]

Just wondering what you meant by the latter. CC intensivist has to do way more shifts than EM physician to earn the same money?

The pay per hour is typically lower for ICU work compared to ER work.

 

[alpinism]

Mind if I ask what an average difference in pay scale is between an Academic and Community EM physician?

Community shops will often pay $50-100 per hour more than academic shops.

 

[NITRAS]

Lots of fellowships focus on how you want to focus your practice rather than more money.

Critical care EDs do exist, although not common.

Lots of people find the BS ED docs have to deal undesirable, and CC give you another practice setting. Different strokes for different folks and all that.

 

[BoardingDoc]

Pain will often result in a pay cut these days from what I hear

Yeah, I suspect that is true. The only reason I added the caveat is that I suspect that you could position yourself as someone who basically only did joint/spine injections all day long after you'd built up your practice if you were so inclined. If you weren't dealing with run of the mill patients and only doing procedures, you would make a killing. That job also sounds insanely boring, but figured I'd mention it to the OP.

 

[Mad Jack]

The real advantage of a fellowship is protection from changing markets- if a CMG starts cutting EM salaries in your area or reducing docs in favor of midlevels, you can transition your practice environment.

 

[Dr.CCM]

It depends where you live and work. The CC job I’m taking next year will pay about the same as the local ER jobs per hour. A little more compared to some and a little less with others. But I don’t have to do any nights. Looking at other places it seems like base pay is less per hour. Like 20-50/hr less for CC. But it depends. Being able to tap out of nights is a lot easier in CC though.

 

[EctopicFetus]

ONe thing to consider is that EM CC doesnt include Pulm. For non academic positions this may be a hinderance if you want to do CC at a community spot as many CC groups spend 1 week a month doing ICU and the rest doing sleep/pulm etc which would wouldnt be trained for.

 

[deleted547339]

The pay per hour is typically lower for ICU work compared to ER work.

Some do, some don’t. Plus, 12 hours in the unit is (on average) easier than 12 hours in the ED.

 

[Money Moniker]

The real advantage of a fellowship is protection from changing markets- if a CMG starts cutting EM salaries in your area or reducing docs in favor of midlevels, you can transition your practice environment.

It doesn't sound like CC is any safer from midlevels than EM.

What is the midlevel situation in CC?

 

[Mad Jack]

It doesn't sound like CC is any safer from midlevels than EM.

What is the midlevel situation in CC?

I've seen more midlevels fired in critical care than hired in the past five years

 

[Hamhock]

In my experience, CCM pays about the same per hour as EM (private world)...a bit more if CCM includes 50/50 overnights.

Furthermore, the typical CCM shift is way easier than an shift in the ED; when measured by what most EM docs consider to be a "hard" shift. The intellectual and emotional stress is often more difficult in the ICU.

HH

 

[Groove]

Mind if I ask what an average difference in pay scale is between an Academic and Community EM physician?

Depends on location. In the S/SE the salary loss in academics is about one quarter to one third what can be made in private practice. That’s a generalization from my experience.

However, everyone working in academics seems to think they make “almost as much” as non-academic jobs and it’s just not the case, at least down here.

The salary loss isn’t quite as much if a CMG is running the ED contract vs hospital employee.

 

[deleted547339]

Depends on location. In the S/SE the salary loss in academics is about one quarter to one third what can be made in private practice. That’s a generalization from my experience.

However, everyone working in academics seems to think they make “almost as much” as non-academic jobs and it’s just not the case, at least down here.

The salary loss isn’t quite as much if a CMG is running the ED contract vs hospital employee.

Yea, I looked in FL and it seems like since the CMGs are running rampant, the difference isn’t all that much.

 

[Dr.CCM]

In my experience, CCM pays about the same per hour as EM (private world)...a bit more if CCM includes 50/50 overnights.

Furthermore, the typical CCM shift is way easier than an shift in the ED; when measured by what most EM docs consider to be a "hard" shift. The intellectual and emotional stress is often more difficult in the ICU.

HH

I completely agree with that. The worst day in the Unit is the eAsiest day I’ve had working in a real ER as far as cognitive load, stress and frustration. now free standings that’s just not the case...

 

[bravotwozero]

maybe it's because I don't have much icu experience (aside from residency rotations), but it seems more challenging intellectually, like I just don't understand how vent settings work..

 

[deleted547339]

maybe it's because I don't have much icu experience (aside from residency rotations), but it seems more challenging intellectually, like I just don't understand how vent settings work..

It is, but it’s less of a grind. You’re not “on” constantly. Also, the more intellectually challenging stuff makes it fun. And as time goes on, most stuff becomes easy (e.g. vents).

 

[Angry Birds]

I did the fellowship. Not for monetary reasons. It makes you more valuable to academic EM departments (as do essentially all fellowship programs), but it doesn’t necessarily make you create more revenue - therefore you won’t get paid more. It technically doubles your job opportunities as you can be an EP or intensivist, but you’d have to give up one. If you want to practice both, it makes it much, much harder to find a job - you need a place big enough to be able to move around faculty to give you a 1/2 FTE EM job and 1/2 FTE ICU job.

That being said, I think if I wanted to do purely academic EM, having the CCM fellowship would likely open most doors. It’s certainly the most rigorous fellowship off of EM, adds a lot to what you can teach residents (or at least gives you the credibility) and is viewed very positively.

I really think we should have a year of just ICU added to our residencies. I wish I did a CC fellowship. Not for anything other than feeling more confident about vents and crap like that. I wouldn't do a CC fellowship, only because I hate training and would need to be forced to do it. I feel like someone should have forced me to do it, which is why I think it should be a req.

 

[tarsuc]

The real advantage of a fellowship is protection from changing markets- if a CMG starts cutting EM salaries in your area or reducing docs in favor of midlevels, you can transition your practice environment.

Depends on location. In the S/SE the salary loss in academics is about one quarter to one third what can be made in private practice. That’s a generalization from my experience.

However, everyone working in academics seems to think they make “almost as much” as non-academic jobs and it’s just not the case, at least down here.

The salary loss isn’t quite as much if a CMG is running the ED contract vs hospital employee.

Yea, I looked in FL and it seems like since the CMGs are running rampant, the difference isn’t all that much.

Forgive me, but whats a CMG. (i did google)

 

[MechEDoc]

Contract management group. E.g. Team Health, Envision, USACS, the devil, etc.

 

[CCM-MD]

AMGA and MGMA medians suggest CCM pays about ~50k more than EM annually.

 

[Dr.CCM]

AMGA and MGMA medians suggest CCM pays about ~50k more than EM annually.

That’s because CC is usually 2 more shifts/month full time. What I had been looking at for full time CC is 14-16/month and mostly 12 hr shifts. EM comp of this is 12, 12hr shifts or about 140ish hrs/month.

Pay per hour is typically a littler higher in EM during my job search.

CC was around 180-240/ hr +RVU bonus at end of year
Real EM was around 210-260/hr usually all RVU