So much doom and gloom but are the numbers disagreeing?

[cyanide12345678]

There has been a lot of doom and gloom scenarios presented here. I myself am becoming a cynic about the future of EM with MLP encroachment, new residencies popping up and increasing supply steadily, CMGs slowly taking over. All of that has been going on for at least the last 5 years and will continue to happen for the coming years.

In 2008 there were 1400 spots. In 2013 there were 165 programs with 1744 spots (25% increase in 5 years). In 2018 there were 220 or so acgme programs with 2278 positions (30 percent increase in 5 years). A lot of these "new spots" in the match in 2018 are likely from the merger of DO/MD programs, so not really new programs. There was a decrease of 100 DO residency spots from 2013 to 2018. So maybe 400 new spots in last 5 years (another 25 percent increase over 5 years).

But the numbers are projecting a different story. Salaries on average continue to rise. And they have done so for the last decade. EM still is the third most highly recruited specially after FM and IM.

So are we at the edge of the cliff with our specialty about to crash once these increasing 2018 residents start graduating? Or is it always just exaggerated doom and gloom? I mean after all, I've personally seen these grim stories being told for at least 5-6 years now. But the numbers don't suport any of that as none of these scenarios have manifested as decreasing salaries. Infact the opposite has continued to happen. See below 2018 and 2014 job data from acepnow. The numbers are far better today than then.

2018-2019 Compensation Report for Emergency Physicians - ACEP Now

How Much Do Emergency Physicians Make? A National Job Market Survey

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[gamerEMdoc]

Personally, I've always been under the belief that its more paranoia. I don't believe our specialty is in trouble at all at the moment. I get peoples concerns about CMGs, midlevels, and new residencies opening, and all of these could present a threat. Or maybe they won't. Maybe we'll all be working for the federal govt in 10 years. Who knows. Heathcare is really unpredictable. But for the past 10 years since I've graduated residency, things on my end have always been improving, not regressing. My residents have always been saught after, and many have gotten really good jobs straight out of residency. I just don't believe our specialty is dying. That doesn't mean we should take the threat of those things mentioned seriously. But I also don't believe the sky is always falling.

The "massive residency expansion" is not really that massive, in fact its pretty much barely increased over the last 5 years. There were 62 AOA EM programs prior to the merger. A few closed, but about 50 or so gained ACGME accredidation. So nearly every one of those "new programs" weren't new at all. They were programs that already existed, that were already pumping out graduates into the workforce. Yes there have been new programs that have opened but there's also been programs that closed too. If there were 165 ACGME programs, and 62 AOA programs, and now there are 220 programs and maybe 10 AOA programs... you realize there hasn't really been a significant net gain of programs over the last 5 years.

 

[cyanide12345678]

In fact if you go back to 2003, there were 1100 residency spots. 900 spots in 1998. So every 5 years there has been a consistent increase in residency spots of about 25 percent for at least the last 20 years. So why haven't we still seen effects of that increase in our compensation as supply has continued to grow?

 

[cyanide12345678]

Agreed. I was giving a generous estimate for the new programs, the actual number could be lower. The way I arrived at 400 ish new spots in 5 years is

(2278 MD spots + 170 DO spots in 2018) - (1744 MD+270 DO spots in 2013) - a little more than 400 basically

The point I'm making is that if you go back into the match data, number of spots have always continued to go up, and so has compensation. historically as a specialty we have thrived despite significant increases in workforce over the last 20 years.

 

[Zebra Hunter]

I’m curious what the 10, 15, 20 year attrition rates are for EM docs who are still working i. the ER. I’d imagine it is fairly low. We are a specialty that retires very early. We also have a large percentage in our specialty that work <30hrs/wk.

 

[gamerEMdoc]

It's a combination of a relatively young specialty growing over several decades, with the workforce switching from non-boarded EM docs to residency trained/boarded EM docs. That doesn't happen overnight. That combined with America's obsession with healthcare utilization and their "I want it now" mentality, and quickly the ED became not just the safety net of the healthcare system, but also the front door of the hospital. The need for residency trained EM docs just continued (and continues) to grow.

 

[gamerEMdoc]

I’m curious what the 10, 15, 20 year attrition rates are for EM docs who are still working i. the ER. I’d imagine it is fairly low. We are a specialty that retires very early. We also have a large percentage in our specialty that work <30hrs/wk.

Yeah its interesting, because its a specialty that allows for a ton of flexibility. You can "retire" early, but still work 2-3 shifts a month at a sleepy place to avoid touching much of your retirement. The fact that the field lets you scale back easily and "retire" early is great for those that can do so, and also great in that its constantly opening up new jobs.

 

[Brigade4Radiant]

Also the population is increasing at a rate of 0.7 yearly and the US population roughly has net increase of about 1 Million yearly total migration. Also the fact that people are living longer and growing sicker we will have more people become elderly and obese. By 2030 the obesity rate is expected to be 50% of the US population. Even if you account AI advances we are safe. Even if the NP's did independent practice and continued to grow at the same rate of schools opening the health care burden is still growing faster than the health workforce.

https://www.hsph.harvard.edu/obesity-prevention-source/obesity-trends/
New research shows increasing physician shortages in both primary and specialty care



When or even if medicine becomes fully automated so will pretty much every job so not much to worry there. ER docs tend to work less as they go on in their careers and you have the general ER attrition rate and the NP/PA attrition rate from ER we will be safe for a good while.

 

[The Knife & Gun Club]

As someone going into EM who reads the constant doom and gloom threads on here it’s nice to know that not everyone thinks the sky is falling

 

[GonnaBeADoc2222]

Anecdotally I have heard of a contracture in the locums market with the $300+ rates harder to find these days. Hopefully this doesn't trickle down.

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[Birdstrike]

There has been a lot of doom and gloom scenarios presented here. I myself am becoming a cynic about the future of EM with MLP encroachment, new residencies popping up and increasing supply steadily, CMGs slowly taking over. All of that has been going on for at least the last 5 years and will continue to happen for the coming years.

In 2008 there were 1400 spots. In 2013 there were 165 programs with 1744 spots (25% increase in 5 years). In 2018 there were 220 or so acgme programs with 2278 positions (30 percent increase in 5 years). A lot of these "new spots" in the match in 2018 are likely from the merger of DO/MD programs, so not really new programs. There was a decrease of 100 DO residency spots from 2013 to 2018. So maybe 400 new spots in last 5 years (another 25 percent increase over 5 years).

But the numbers are projecting a different story. Salaries on average continue to rise. And they have done so for the last decade. EM still is the third most highly recruited specially after FM and IM.

So are we at the edge of the cliff with our specialty about to crash once these increasing 2018 residents start graduating? Or is it always just exaggerated doom and gloom? I mean after all, I've personally seen these grim stories being told for at least 5-6 years now. But the numbers don't suport any of that as none of these scenarios have manifested as decreasing salaries. Infact the opposite has continued to happen. See below 2018 and 2014 job data from acepnow. The numbers are far better today than then.

2018-2019 Compensation Report for Emergency Physicians - ACEP Now

How Much Do Emergency Physicians Make? A National Job Market Survey

Increasing amounts of midlevels and residency positions are not going to ruin your career. That is simply an inevitable, needed and long overdue response to increase supply due to the 30 years (or more) long Emergency Physicians shortage. In fact, it may even improve your work career to the point you may not constantly be pressured, or forced, to work beyond a mentally healthy or sustainable work load, work pace and shift quantity. This is simply not something I would worry about. I spent a decade in EM begging, hoping, wishing this would happen. It's a good thing. You shouldn't fear it. Salaries will hold. You may not get $500 per hour to cover desperate God forsaken hell holes anymore if there's not a critical shortage. But salaries will hold.

How do I know that? Because the more providers they put out (supply) will simply lead to lower wait times, will will increase the amount of patients (supply) coming in. It's simple supply and demand. This will not put your career at risk. Mark my words.

What will put your career at risk, is dealing with physical and mental stress of circadian-rhythm shift-work disorder combined with the stress, pace and acuity of the job. That is by far, the biggest threat to your career and job satisfaction. By far. Nothing else is even in the same building, to compete with this as your biggest career threat. You've got to fix it for yourself. (My solution: Do any EM fellowship that allows you to get out of circadian rhythm toxic work.)

Having extra docs and PAs to help out (finally!) to deal with overwhelmed and perpetually growing ED volume?

Not a bad thing. It's 100%, categorically, unambiguously, a good thing for you.

 

[GeneralVeers]

High rate locums is basically gone. The bubble has burst in Texas and to a lesser extent Florida. This is primarily due to their being no longer a shortage of EM docs as Freestanding EDs have gone bankrupt and closed up. Additionally CMGs have gotten smarter, and are better at recruiting and staffing so they no longer have to pay outrageous rates.

That being said, my rate at "home" is twice what I was making in the local market 5 years ago.

 

[Birdstrike]

As someone going into EM who reads the constant doom and gloom threads on here it’s nice to know that not everyone thinks the sky is falling

The sky is not falling in the specialty of EM. The whole world is literally ending in 12 years, tho

"The world is going to end in 12 years"- Alexandria Ocasio Cortez, 1/21/19

Set your countdown clock, bishes

 

[GeneralVeers]

The sky is not falling in the specialty of EM. The whole world is literally ending in 12 years, tho

"The world is going to end in 12 years"- Alexandria Ocasio Cortez, 1/21/19

See your countdown clock, bishes

She's one smart lady.

 

[Birdstrike]

She's one smart lady.

Yes, she is. I wonder if she'll propose invading China & India, the worlds largest CO2 emitters to, "Like, ya know. Save the world?"

 

[namethatsmell]

She's one smart lady.

She's displaying a presidential level of intelligence.

 

[GeneralVeers]

Yes she is. I wonder if she'll propose invading China & India, the worlds largest CO2 emitters to, "Like, ya know. Save the world?"

We will never know because we won't have the basics of civilization, like electricity or a working monetary system.

 

[GeneralVeers]

She's displaying a presidential level of intelligence.

#AOCforPrez

 

[twospadz]

There has been a lot of doom and gloom scenarios presented here. I myself am becoming a cynic about the future of EM with MLP encroachment, new residencies popping up and increasing supply steadily, CMGs slowly taking over. All of that has been going on for at least the last 5 years and will continue to happen for the coming years.

In 2008 there were 1400 spots. In 2013 there were 165 programs with 1744 spots (25% increase in 5 years). In 2018 there were 220 or so acgme programs with 2278 positions (30 percent increase in 5 years). A lot of these "new spots" in the match in 2018 are likely from the merger of DO/MD programs, so not really new programs. There was a decrease of 100 DO residency spots from 2013 to 2018. So maybe 400 new spots in last 5 years (another 25 percent increase over 5 years).

 

[Brigade4Radiant]

Maybe in locums Texas but you can make 300-400 in Mississippi. Locums rates have gone down due to people taking “firefighter” locums jobs.

 

[Birdstrike]

#AOCforPrez

F- that

#AOCforDictator

 

[namethatsmell]

#AOCforPrez

Heh true. Though I was trying to suggest she's operating on Trump's level. Seems my sarcasm can't penetrate the internets.

 

[Fox800]

The Texas bubble has burst. Jobs in the metro areas are running dry and hourly rates are way down. You can get a job, but it doesn't pay nearly as well as the $275-300+/hr stuff that was routinely advertised just a few years ago.

Almost everything is overrun by Envision, USACS, or TEAMHealth.

 

[namethatsmell]

To the original premise of the thread, I also don't think the sky is falling from a monetary perspective. Within the last year I've had shifts where I got 500/hr... but there's a reason places need to pay this and yet are still always looking for help. They're complete dumpster fires to work at. The sky falling on our field isn't just about the money. It seems like our field is getting tougher and tougher to work in every year in other regards.

Despite all these extra "providers" entering the field I am not seeing an improvement in staffing levels. Health systems and CMGs are still greedy and short-sighted and will replace you with a cheaper worker whenever possible. I've never seen a place increase physician staffing levels unless 1) the contract was at risk or 2) a major safety event occurred attributable to staffing. I worked at a place that tried to replace 35% doc hours with midlevel hours. It was horrendous and patients got hurt. I recall having to sign like 120 midlevel charts after one shift there on patients there was no feasible way I could see. I think that shift aged me half a year. Silver lining was the admins precious metrics also went to ****.

I think the most useful thing to keep the sky from falling on our field would be staffing changes that actually make things better and saner for docs and midlevels and patients. The older I get, the more I care about not getting destroyed by a torrent of patients every shift and having a few minutes to actually eat. The amount of time spent chained to an EMR doesn't help. When charting takes 1-2 extra hours after a busy shift it's a burnout catalyst. Oh, and stop having us serve as a) social workers, b) secretaries, c) custodians ... I've worked at places where docs have been asked to "cover" the duties of these folks when the health system fired them.

So yeah, money-wise EM is OK for right now. The medicine aspect is still cool. But you need to be very, very picky about where you work. And you need to pay off your debt ASAP and save up an FU fund for when your job turns turns to crap overnight. That way you can walk to greener pastures and preserve your sanity and sense of self-worth. Along the way, have an exit plan of some sort like birdstrike.

 

[GeneralVeers]

Heh true. Though I was trying to suggest she's operating on Trump's level. Seems my sarcasm can't penetrate the internets.

Although maybe lacking in facts, at least Trump has some grasp of a market economy. I'd gladly take his economic ignorance over hers any day as it will cost me a lot less money.

 

[Brigade4Radiant]

She can probably become president in the next 8 years not joking. It seems moderates are done for.

 

[bravotwozero]

She can probably become president in the next 8 years not joking. It seems ESTABLISHMENT POLITICIANS TAKING SUPERPAC MONEY are done for.

Fixed that for you...



Sent from my iPhone using Tapatalk

 

[Brigade4Radiant]

Fixed that for you...



Sent from my iPhone using Tapatalk

Don’t get me wrong I like her

 

[TulaneUnderdog]

I also simply believe in a strong future for this specialty unlike that for Rads and Path whose futures are definitely being threatened. I don't have a crystal ball to prognosticate accurately, but I remember my ER attending saying it perfectly "the best way to specialize for the future is to not specialize" . I interpret that as working as a hospitalist/generalist/doctor having broad knowledge of all organ systems and hospitals/UC are realizing that ER docs work well in those areas as well.

 

[miacomet]

Although maybe lacking in facts, at least Trump has some grasp of a market economy. I'd gladly take his economic ignorance over hers any day as it will cost me a lot less money.

Uh, no. Someone who inherits 400mm and burns through it and declares bankruptcy? Trade wars and tariffs? He understands nothing, and I'm pretty sure he's functionally illiterate.

 

[TulaneUnderdog]

Uh, no. Someone who inherits 400mm and burns through it and declares bankruptcy? Trade wars and tariffs? He understands nothing, and I'm pretty sure he's functionally illiterate.

 

[Shufflin]

Uh, no. Someone who inherits 400mm and burns through it and declares bankruptcy? Trade wars and tariffs? He understands nothing, and I'm pretty sure he's functionally illiterate.

It's too early to say for certain what the outcome of Trump’s tariffs and other trade policies will be. Trump’s trade agenda was busy in 2018, and there's much more to come in just the first quarter of 2019 which will be pivotal. I encourage you to look at the facts. Trade is VERY complex, and he has an army working on it. European Union Trade Commissioner Cecilia Malmstrom and U.S. Trade Representative Robert Lighthizer have been meeting for months. U.S. government delegations have been traveling to Beijing for trade talks numerous times with an aim to negotiate with a stronger will than prior presidents. Trump has a strategy to tighten restrictions on high-tech American exports. Then there's the U.S.-Japan Trade Agreement negotiations this month. On the U.S.-Mexico-Canada Agreement, Democrats will prolong the finalization of that undoubtedly. As for the benefits of free trade during the Obama years, it wasn't truly free and it wasn't truly fair to the U.S.

You gotta look at the details whether you like Trump or not. I don't swing either direction, just one of the few willing to look at the complexity of it.

 

[Mad Jack]

In fact if you go back to 2003, there were 1100 residency spots. 900 spots in 1998. So every 5 years there has been a consistent increase in residency spots of about 25 percent for at least the last 20 years. So why haven't we still seen effects of that increase in our compensation as supply has continued to grow?

Because there was plenty of room for graduates since most ERs in the 90s were not staffed by EM trained doctors. Training never kept up with staffing. There also was not a midlevel glut.

The big issue with EM is that if an excess of providers happens, there are very few places for EM trained docs to work outside of emergency departments, so ensuring supply does not outstrip demand is critical to the long-term survival of the specialty. Any provider excess is probably many years off, however, and I doubt today's trainees face anything to worry about

 

[wamcp]

Increasing amounts of midlevels and residency positions are not going to ruin your career. That is simply an inevitable, needed and long overdue response to increase supply due to the 30 years (or more) long Emergency Physicians shortage. In fact, it may even improve your work career to the point you may not constantly be pressured, or forced, to work beyond a mentally healthy or sustainable work load, work pace and shift quantity. This is simply not something I would worry about. I spent a decade in EM begging, hoping, wishing this would happen. It's a good thing. You shouldn't fear it. Salaries will hold. You may not get $500 per hour to cover desperate God forsaken hell holes anymore if there's not a critical shortage. But salaries will hold.

How do I know that? Because the more providers they put out (supply) will simply lead to lower wait times, will will increase the amount of patients (supply) coming in. It's simple supply and demand. This will not put your career at risk. Mark my words.

What will put your career at risk, is dealing with physical and mental stress of circadian-rhythm shift-work disorder combined with the stress, pace and acuity of the job. That is by far, the biggest threat to your career and job satisfaction. By far. Nothing else is even in the same building, to compete with this as your biggest career threat. You've got to fix it for yourself. (My solution: Do any EM fellowship that allows you to get out of circadian rhythm toxic work.)

Having extra docs and PAs to help out (finally!) to deal with overwhelmed and perpetually growing ED volume?

Not a bad thing. It's 100%, categorically, unambiguously, a good thing for you.

Why no fear for political change? That’s the biggest threat to all specialties not just EM.

70% of Americans now support Medicare-for-all—here's how single-payer could affect you

For an example look at this job posting in the UK.
Consultant Emergency Medicine job with East Kent Hospitals University NHS Foundation Trust | 81806

How many of you would work for that garbage compensation just so everyone can have ‘free’ healthcare?

Also if you didn’t know, that NHS job description says 12 PA of work which means 48 Hours of work in the ER each week, for a salary of 101 to 136k usd a year.

Can any of you imagine working like that?

 

[The Knife & Gun Club]

Why no fear for political change? That’s the biggest threat to all specialties not just EM.

70% of Americans now support Medicare-for-all—here's how single-payer could affect you

For an example look at this job posting in the UK.
Consultant Emergency Medicine job with East Kent Hospitals University NHS Foundation Trust | 81806

How many of you would work for that garbage compensation just so everyone can have ‘free’ healthcare?

Also if you didn’t know, that NHS job description says 12 PA of work which means 48 Hours of work in the ER each week, for a salary of 101 to 136k usd a year.

Can any of you imagine working like that?

With all due respect it’s apples to oranges. They have a totally different health care, education, and social service structure in the U.K.

Also no one reasonable is trying to build a VA/NHS type health system for all in the US. Even Bernie knows that wouldn’t work.

 

[Birdstrike]

Why no fear for political change? That’s the biggest threat to all specialties not just EM.

I didn't post about "political change" because the thread is not about political change. But for what it's worth, I agree with you. Allowing the government to have a full blown stranglehold on healthcare, beyond that which they already have, is a threat to our careers as physicians, absolutely. And it would be no better for patients. Just look at our government's real world field experiment in all-government run healthcare: The VA system. In my opinion, they should never get a chance at "running healthcare" en total, until they prove they can fix the VA and make it a system we all respect and envy. For the record, I don't expect that to happen in my lifetime.

In general, my personal bias is that if there's any way we can manage anything, without the government being involved we should choose independence over surrender to government. I'm not saying everything the government runs is a s**t show, but a lot of it is. It almost seems that in general, if there's any way humanly possible to have something run not by the government, but by people with something to gain if it succeeds and something to lose if it fails, that you should go that route, instead of having it run by the government which is never accountable.

In other words, give me the choice between paying for one of the cheeses in my local supermarket, over being force fed "free" government cheese for life with no escape, and I'll buying cheese on my own every time.

 

[deuist]

For an example look at this job posting in the UK.
Consultant Emergency Medicine job with East Kent Hospitals University NHS Foundation Trust | 81806

I'm not sure why you would link to a job offer in England. You should at least look toward the VA in the United States as an example of government-run health care. Further, advocating Medicare for everyone is not the same as government-directed hospitals.

 

[WilcoWorld]

The sky is not falling in the specialty of EM. The whole world is literally ending in 12 years, tho

"The world is going to end in 12 years"- Alexandria Ocasio Cortez, 1/21/19

Set your countdown clock, bishes

"Her comments are in reference to a United Nations-backed climate report, published late last year, that determined the effects of climate change to be irreversible and unavoidable if carbon emissions are not reined in over the next 12 years."

True, it was hyperbolic. Irreversible and unavoidable climate change =/= the end of the world.

The cockroaches, tardigrades, and probably even the Papua New Guineans (at least the Highlanders) will be just fine.

 

[Apollyon]

"Her comments are in reference to a United Nations-backed climate report, published late last year, that determined the effects of climate change to be irreversible and unavoidable if carbon emissions are not reined in over the next 12 years."

True, irreversible and unavoidable climate change =/= the end of the world.

The cockroaches, tardigrades, and probably even the Papua New Guineans (at least the Highlanders) will be just fine.

Can always count on you for erudition!

 

[Birdstrike]

"Her comments are in reference to a United Nations-backed climate report, published late last year, that determined the effects of climate change to be irreversible and unavoidable if carbon emissions are not reined in over the next 12 years."

True, irreversible and unavoidable climate change =/= the end of the world.

The cockroaches, tardigrades, and probably even the Papua New Guineans (at least the Highlanders) will be just fine.

Thanks. I feel much better now knowing I'll get through it.

 

[WilcoWorld]

Can always count on you for erudition!

And I can always count on you to appreciate it!

 

[WilcoWorld]

Thanks. I feel much better now knowing I'll get through it.

well played

 

[miacomet]

Why no fear for political change? That’s the biggest threat to all specialties not just EM.

70% of Americans now support Medicare-for-all—here's how single-payer could affect you

For an example look at this job posting in the UK.
Consultant Emergency Medicine job with East Kent Hospitals University NHS Foundation Trust | 81806

How many of you would work for that garbage compensation just so everyone can have ‘free’ healthcare?

Also if you didn’t know, that NHS job description says 12 PA of work which means 48 Hours of work in the ER each week, for a salary of 101 to 136k usd a year.

Can any of you imagine working like that?

Yes, UK EM docs are robbed, which is why they can't fill their EM residency slots, and why the docs they do graduate decamp to Australia and Canada, which pay similarly to the US. Do note, though that the posted job requires no nights and one in seven weekends, and comes with six weeks vacation, a year of maternity leave, and job security. Also, they work a 40 hour week inthe NHS, some of which is nonclinical. I'm not sure where you get 48 hours. Note that docs also get extra pay for evenings/weekends/holidays. Agreed, though, that it's a tough sell.

Why are you convinced that a Medicare-for-all or other national health program would end up like the NHS, not like Canadian or Australian systems, where docs are compensated similarly to the US, but with cheaper training and less liability? How do you know?

 

[wamcp]

I'm not sure why you would link to a job offer in England. You should at least look toward the VA in the United States as an example of government-run health care. Further, advocating Medicare for everyone is not the same as government-directed hospitals.

The VA in my area pays 180/hr for ER work. You think they will still pay exactly 180/hr if the US health system becomes “VA for all”? Obviously not, if the government doesn’t have to compete against non-VA hospitals for ER doctors, they 100% guaranteed WILL lower that pay to match that of the NHS or worse, in order to cut costs as much as they think they can.

 

[miacomet]

The VA in my area pays 180/hr for ER work. You think they will still pay exactly 180/hr if the US health system becomes “VA for all”? Obviously not, if the government doesn’t have to compete against non-VA hospitals for ER doctors, they 100% guaranteed WILL lower that pay to match that of the NHS or worse, in order to cut costs as much as they think they can.

Why do Canada and Australia pay well?

 

[miacomet]

Maybe in locums Texas but you can make 300-400 in Mississippi. Locums rates have gone down due to people taking “firefighter” locums jobs.

Yes, I hate the *****s that take those jobs. @GamerDoc needs to school his residents, as I'm sure he does Nothing good ever came from a firefighting gig in EM.

 

[Birdstrike]

The VA in my area pays 180/hr for ER work. You think they will still pay exactly 180/hr if the US health system becomes “VA for all”? Obviously not, if the government doesn’t have to compete against non-VA hospitals for ER doctors, they 100% guaranteed WILL lower that pay to match that of the NHS or worse, in order to cut costs as much as they think they can.

Yep, you can bet your arshnickle that whatever pay is, it'll go down under a "VA for all," "Medicare for all" or any other government heavy system. "Rich, greedy overpaid doctors" who are "bankrupting the system" will be a very easy target for the AOCs of the world to convince her capitalism-hating millennial followers to be tapped as a money source to try to pay for it. After all, to them anyone "successful" has gotten where they are off the backs of the poor and aggrieved. Then, if you don't like your socialist "Green" (raw) deal as a physician that you got swindled into buying into, your only recourse is to leave the system, possibly the country if there is no competing private system, or go on strike if the government even allows that to be legal.

Doctors gave away their independence to hospitals, insurance companies and most recently, hospitals. Now they b***h about feeling like "cogs in a machine." Well, yes, when you sign up to be a replaceable, unappreciated cog in a machine, you might end up feeling like a replaceable, unappreciated cog in a machine.

 

[wamcp]

Why do Canada and Australia pay well?

Um they don’t, here is a locums post in Australia.
Specialist Emergency Medicine Physician job at Skilled Medical in New South Wales | Jora

Convert that to USD and that’s 142 an hour for LOCUMS work. Keep in mind taxes are MUCH higher over there too. About 35% effective tax at that rate, and that’s just for their ‘federal’ tax alone. Lol

 

[BoardingDoc]

Um they don’t, here is a locums post in Australia.
Specialist Emergency Medicine Physician job at Skilled Medical in New South Wales | Jora

Convert that to USD and that’s 142 an hour for LOCUMS work. Keep in mind taxes are MUCH higher over there too. About 35% effective tax at that rate, and that’s just for their ‘federal’ tax alone. Lol

Literally the next 2 listings on that site show a rate of 250 AUD/hr instead of the 200/hr jobs you posted.
First
Second
That particular company also seems to have lower paying jobs than others out there.

Looking quickly at other locums sites such as Here shows that ED docs make 250-500k / yr there, which is comparable to US salaries. As to your statement that the VA will "100% guaranteed" drop pay if everyone has to work for the VA... that might happen, it might not. The salaries for NHS docs would seem to support that argument. Salaries in Canada and Auz (as I just illustrated) do not.

 

[miacomet]

Yep, you can bet your arshnickle that whatever pay is, it'll go down under a "VA for all," "Medicare for all" or any other government heavy system. "Rich, greedy overpaid doctors" who are "bankrupting the system" will be a very easy target for the AOCs of the world to convince her capitalism-hating millennial followers to be tapped as a money source to try to pay for it. After all, to them anyone "successful" has gotten where they are off the backs of the poor and aggrieved. Then, if you don't like your socialist "Green" (raw) deal as a physician that you got swindled into buying into, your only recourse is to leave the system, possibly the country if there is no competing private system, or go on strike if the government even allows that to be legal.

Doctors gave away their independence to hospitals, insurance companies and most recently, hospitals. Now they b***h about feeling like "cogs in a machine." Well, yes, when you sign up to be a replaceable, unappreciated cog in a machine, you might end up feeling like a replaceable, unappreciated cog in a machine.

So, Canada? It pays well, some areas better than the US. How does that happen?

Aus may pay a bit less (although there are perm jobs offering over 350k AUS), but their superannuation is incredible, they work no nights and fewer weekends), have almost no liability, and tons of vacay/annual leave. To me that's a fair trade, especially with better longevity without circadian issues.