So if a hsopital hires an FP to work in an ER, will he or she be paid different compared to an EM trained physician?
salary difference for an FP in EM compared to an EM doc?
- Thread starter soxman
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Ive been told that is so. Primairly b/c the contractor paying the ED doctor usually pays malpractice ins and such...usually that is higher for non EM boarded people. Also, they will simply just want to pay EM boarded people more money to make sure they stick around if they are in a low served area....
I'll be anxious to here what the more senior have to say as well..
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I'm not sure about the salary, but career longevity is something to consider. I have personally seen cases where insurance companies threatened to drop coverage on EDs with non-BC EPs. This resulted (both times) in the hospital hiring contract groups. The groups kept the BC/BE EPs and promptly fired the FPs (actually, they just didn't hire them). One of those cases was at a hospital that houses a FM residency and several attendings of >15 years experience were let go. Try going "back to the office" after 15 years in the pit.
Look, it has been said before, but I'll say it again. If you want to do family medicine, do family medicine. If you want to do emergency medicine, do emergency medicine. It is very poor career planning to assume you can do both, and the usual motivation for doing so (that you can "retire" from emergency medicine and open a FM practice) is bunk. After years in the pit your long-term illness management skills will be hopelessly out of date. Like EM, FM is a specialty, you can't just jump into it after years of not doing it.
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Amen.
One of my classmates is applying for IM but he was telling me that he plans to do "alot of ER work" after he finishes residency. Sheesh.
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typically, hospitals don't hire physicians.
your question seemingly assumes that all physicians of a given specialty are paid the same... but there are many other factors to consider including length of time out of residency, location, demand/volume, average payor status, etc. also, don't forget the negotiating power of the physician himself/herself.
depends where you're friend ends up working... large academic center, likely won't happen. but in a smaller community hospital, it could happen...
with that said, i do agree with foughtfyr.
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I know lots of people doing IM or FP and planning on 'working in the ER a lot'....I tried to convince them, but they think I am the silly one off doing a 'hard' residency away from home. I'll still be doing what I love in ten years....
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I don't really know how our EPs are paid since they don't share that info with us lowly PAs. the PAs are a straight salary and the EPs are paid on production. Trouble is, our fast track is staffed by a couple of FPs and locums in addition to PAs. One of our fast track FPs just confided in us that his pay (based on RVUs) had been reduced three months in a row because someone decided he was making too much money. And he really moves the meat. I thought that was sucky. Apparently he did too because he'll be moving on, probably to outpatient family medicine. Bummer all around because he's a good doc and we like working with him. 😡
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I agree with FF. If you want to do emergency medicine, you should train in emergency medicine. If you want to do both, then look at one of the combined EM/FP or EM/IM programs.
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Aren't "most" rural-type ED's run by FP's? If you read the want ads online, looks like all are hiring FP but obviously prefer EM trained. I know a few level I's where there is one or two FP's on staff, and the outlying hospitals in that area are about 50% FP trained.
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This probably won't be seen that often in 10-15 years.
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I wouldn't mind, but will probably take longer than that.
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This is true, and the time course for the cessation of this practice is certainly a discussion onto itself. That said, as a career, entering family medicine to do emergency medicine is a foolish endeavor. Any ED job found will live under a "Sword of Damocles" both in terms of malpractice and the possibility of losing your job to a residency trained EP. It should be remembered that an FP practicing in the ED will be held to the same standards of care that a BC EP will. In a malpractice case there is no question that a plaintiff's attorney will highlight every difference in the training. For this reason, several large insurance companies are refusing to insure hospitals who use non BC emergency physicians to staff their EDs. Should the insurer where you work decides to do this, the FP will, nearly instantly and through no fault of their own, lose their job. So, planing on this type of practice seems foolish...
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Ahhhhhh!!! Rocky Horror flashback....
The sword of Damocles is hanging over my head,
And I've got the feeling someone's gonna be cutting the thread,
Sha-la-la-la that ain't no crime.....
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I still have the gold trunks around here somewhere (after one too many audience participation nights I got drafted into absent friends for a couple of months - the old 400 theater in Chicago).
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i see my error. i should have limited my comments to california, as in california, hospitals do not hire physicians- with the exception being er, pathology, and radiology through exclusive contracts; as well as the county health care system and university of california health care system.
in other states, yes, hospitals employ physicians.
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I'm a third year FP resident in Wyoming. I will graduate in June and hope to begin a second residency in EM next July. Now, why on earth would I want to subject myself to the Match again and go through another residency just to work in a rural ED? Well, here's why:
I chose U Wyoming Casper FP because it offers an Emergency Med/Acute Care track for those interested in rural EM. Three years ago the majority of Wyoming ED's were staffed with mostly FP's. There is a huge shortage of BC/BE EM docs out there who are willing to come to Wyoming. Over half of our FP graduates are currently working in ED's across Wyoming. So, I thought that FP w/ an ED track and my long career as a paramedic would be prepare me adequately for be an EM physician. After 6 months in FP I quickly changed my mind. First off, there is NO substitute for the training you will receive in an EM residency program. Second, FP residency only gives you a month in the ER as an intern and a month in your 3rd year. Obviously you can do electives in the ED but you will be in clinic SO MUCH (especially in PGY-3) that your experience in the ED will be very limited. The EM track offers some good trauma opportunities but again, your FP responsibilities come first so it's hard to get to the ED for the Code Reds during the day. And sure, you can moonlight in some of the rural ER's but do you really want to take on that liability without being properly trained? I hope you do not.
Last year, the Institute of Medicine published a statement calling for increased EM BC physicians in rural areas. With the increase in EM residency programs in states with underserved populations, there will be a lot more BC EM docs graduating and going into rural areas. This is great for the profession and finally, there is a dual FP/EM residency in Delaware and hopefully, there will be others in more rural/underserved areas in the coming years. The DO's have known the value of combining FP and EM for years. Dual FP/EM makes sense in terms of the broad spectrum of medicine covered. As much as I dislike Ob (an understatement), I am really glad I have had the training "ad nauseum" in it because most EM residency programs only give you a month.
Obviously, there will always be places in the US that are so understaffed that FP's will cover ED's, but the positions are drying up. Every single one of our ED docs has encouraged me to pursue a second resdeincy and be board certified in EM and then come back to Wyoming. We have 2 new docs who just graduated from EM residencies and they are outstanding, not only in their practice but in how they are teaching our residents and prehospital providers.
My fellow classmates and FP attendings think I'm out of my mind for pursuing a second residency in EM but to me it is worth the 2 1/2 - 3 extra years of training to know that I have been properly prepared not only as an ED physician but as an EMS educator and administrator. I just hope I get the chance this year......
If anyone out there is interested in FP or EM oportunities in Wyoimng or any of the Western Frontier states, please send me a private message. I'll be happy to answer any questions.
Apologies in advance for any typos....
Good luck to all this year.
RC
I chose U Wyoming Casper FP because it offers an Emergency Med/Acute Care track for those interested in rural EM. Three years ago the majority of Wyoming ED's were staffed with mostly FP's. There is a huge shortage of BC/BE EM docs out there who are willing to come to Wyoming. Over half of our FP graduates are currently working in ED's across Wyoming. So, I thought that FP w/ an ED track and my long career as a paramedic would be prepare me adequately for be an EM physician. After 6 months in FP I quickly changed my mind. First off, there is NO substitute for the training you will receive in an EM residency program. Second, FP residency only gives you a month in the ER as an intern and a month in your 3rd year. Obviously you can do electives in the ED but you will be in clinic SO MUCH (especially in PGY-3) that your experience in the ED will be very limited. The EM track offers some good trauma opportunities but again, your FP responsibilities come first so it's hard to get to the ED for the Code Reds during the day. And sure, you can moonlight in some of the rural ER's but do you really want to take on that liability without being properly trained? I hope you do not.
Last year, the Institute of Medicine published a statement calling for increased EM BC physicians in rural areas. With the increase in EM residency programs in states with underserved populations, there will be a lot more BC EM docs graduating and going into rural areas. This is great for the profession and finally, there is a dual FP/EM residency in Delaware and hopefully, there will be others in more rural/underserved areas in the coming years. The DO's have known the value of combining FP and EM for years. Dual FP/EM makes sense in terms of the broad spectrum of medicine covered. As much as I dislike Ob (an understatement), I am really glad I have had the training "ad nauseum" in it because most EM residency programs only give you a month.
Obviously, there will always be places in the US that are so understaffed that FP's will cover ED's, but the positions are drying up. Every single one of our ED docs has encouraged me to pursue a second resdeincy and be board certified in EM and then come back to Wyoming. We have 2 new docs who just graduated from EM residencies and they are outstanding, not only in their practice but in how they are teaching our residents and prehospital providers.
My fellow classmates and FP attendings think I'm out of my mind for pursuing a second residency in EM but to me it is worth the 2 1/2 - 3 extra years of training to know that I have been properly prepared not only as an ED physician but as an EMS educator and administrator. I just hope I get the chance this year......
If anyone out there is interested in FP or EM oportunities in Wyoimng or any of the Western Frontier states, please send me a private message. I'll be happy to answer any questions.
Apologies in advance for any typos....
Good luck to all this year.
RC
