So much doom and gloom but are the numbers disagreeing?

[miacomet]

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.

Thank you for using...evidence! There are insanely low-paid locums in the US, also. I get emails regularly offering $100 an hour for "easy" jobs. I think folks have a hard time accepting that Aussie docs might have the best gig of all.

As I'm sure @Birdstrike knows, the NHS has such a hard time staffing their ERs that locums pays well over £100 an hour. And that's for weekday, day or evening shifts. Oh, and the hospitals have pubs.

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[Birdstrike]

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.

I don't know how Canada and Australia do anything, but there no ***king way our lawyers and Congress of lawyers are going to bankrupt the medial malpractice industry and give us that deal. Are you kidding me? No ***king way. I'd move to Australia for the no-nights before I get suckered into believing lawyers and our Congress of lawyers of our country going to give us immunity to malpractice and somehow magically take away nights shifts for doctors and stop caring about patient satisfaction, while patients are forced to either wait and see non-physicians all night, while they blow up every patient satisfaction survey they can find, while calling lawyers to sue for discrimination and violation of "rights" for not being able to see a physician within 15 minutes at 3:30 am for their non-emergency. Our culture is so different in so many ways than the cultures of the countries you are naming, that I don't know that there's any meaningful comparisons to be made at all.

Bottom line: Yes, I'd take that deal. No I don't think you can bring it here with radical socialism, without destroying the good with the bad. I tend to lean towards optimism lately, but count me as a skeptic on this one. And because I'm a skeptic, that's why I took matters into my own hands and got out, which took 12 months to achieve, which is much faster than the time it will take to reinvent the entire healthcare system (and culture) of America.

 

[miacomet]

I don't know how Canada and Australia do anything, but there no ***king way our lawyers and Congress of lawyers are going to bankrupt the medial malpractice industry and give us that deal. Are you kidding me? No ***king way. I'd move to Australia for the no-nights before I get suckered into believing lawyers and our Congress of lawyers of our country going to give us immunity to malpractice and somehow magically take away nights shifts for doctors and stop caring about patient satisfaction, while patients are forced to either wait and see non-physicians all night, while they blow up every patient satisfaction survey they can find, while calling lawyers to sue for discrimination and violation of "rights" for not being able to see a physician within 15 minutes at 3:30 am for their non-emergency. Our culture is so different in so many ways than the cultures of the countries you are naming, that I don't know that there's any meaningful comparisons to be made at all.

Bottom line: Yes, I'd take that deal. No I don't think you can bring it here with radical socialism, without destroying the good with the bad. I tend to lean towards optimism lately, but count me as a skeptic on this one. And because I'm a skeptic, that's why I took matters into my own hands and got out, which took 12 months to achieve, which is much faster than the time it will take to reinvent the entire healthcare system (and culture) of America.

I agree @Birdstrike , which is why I'm completely confused as to why you brought up the NHS. We are much more similar to Canada and Australia than the UK. Why are the NHS and the UK a better comparison?

 

[Birdstrike]

I agree @Birdstrike , which is why I'm completely confused as to why you brought up the NHS. We are much more similar to Canada and Australia than the UK. Why are the NHS and the UK a better comparison?

I didn't bring up the NHS. That was someone else.

 

[GeneralVeers]

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.

Well the supposed immense policy literacy of the last President led to multiple wars we didn't need to be involved with. His brilliance at economics cost me at least $80K over the course of his tax increase, and importantly my health insurance premiums doubled while also getting a much worse policy. I'll gladly take the guy who is saving me $22K in taxes this year, getting us out of foreign wars, and rightly punishing the Chinese for stealing our IP.

 

[GeneralVeers]

With regards to Medicare-for-all, what most poeople don't grasp is that paying Medicare rates for EVERY patient would immediately cause many hospitals to close their doors as they would be unable to meet their costs with Medicare payments alone. Those that survive would only be able to do so with reduced services, like changing nursing ratios, no 24-hour cath lab, etc. It would be incredibly disruptive to care delivery.

I've looked at Australia jobs before and in the past have seen a number paying $300-400K. That looks great on paper, but when you calculate the total tax burden, it comes to about 38% of salary (versus about 30% in a tax-free U.S.) state. That doesn't leave much take-home pay. Additionally do you want to live in Sydney or Melbourne? They are two of the most expensive cities in the world for housing with costs comparable to SFO or LA.

 

[miacomet]

With regards to Medicare-for-all, what most poeople don't grasp is that paying Medicare rates for EVERY patient would immediately cause many hospitals to close their doors as they would be unable to meet their costs with Medicare payments alone. Those that survive would only be able to do so with reduced services, like changing nursing ratios, no 24-hour cath lab, etc. It would be incredibly disruptive to care delivery.

I've looked at Australia jobs before and in the past have seen a number paying $300-400K. That looks great on paper, but when you calculate the total tax burden, it comes to about 38% of salary (versus about 30% in a tax-free U.S.) state. That doesn't leave much take-home pay. Additionally do you want to live in Sydney or Melbourne? They are two of the most expensive cities in the world for housing with costs comparable to SFO or LA.

Sure. But you also get 8% of your salary in superannuation, and you don't have to pay health insurance premiums. Agreed the cost of living is high, but so is quality of life.

 

[emergentmd]

I am not sure pay has gone down much but the upper hand has definitely swung from the Docs to the CMGs.

In Texas, it used to be that almost every city was understaffed and high rates/bonuses were offered routinely. Now it is hard to find a full time spot in most of the Big cities and bonuses are gone. All due to the influx of docs, increased residency, contraction of FSERs, and closing of Hospitals in Houston doe to the hurricane.

But overall, I would say pay has not gone down much.

 

[Birdstrike]

Sure. But you also get 8% of your salary in superannuation, and you don't have to pay health insurance premiums. Agreed the cost of living is high, but so is quality of life.

I do know a guy who moved to New Zealand to practice EM for a year. He liked it so much, he packed up and moved his family there permanently, for the reasons you describe.

 

[Fox800]

I do know a guy who moved to New Zealand to practice EM for a year. He liked it so much, he packed up and moved his family there permanently, for the reasons you describe.

Thinking about doing this myself in the next few years.

 

[southerndoc]

People seem to be overlooking the bigger elephant in the room: the threat of APP's. The rate of NP's and PA's graduating has increased. I've posted about this in detail in another thread. I'm too tired and lazy to look it up now (finishing a late shift).

 

[Brigade4Radiant]

PA's NP affect all of medicine also with residents there is a 3 year cap before they can enter the market. Even then health care needs are only going to increase with more obesity and a greater % of the population aging and growing

 

[GeneralVeers]

Sure. But you also get 8% of your salary in superannuation, and you don't have to pay health insurance premiums. Agreed the cost of living is high, but so is quality of life.

Just read about the super-annuation. Doesn't quite make up for the decreased salary, and higher taxes, but it's an intriguing concept. This is really what Social Security should be: a private fund that you own which is paid into by the employer.

I've spend loads of time in Australia (med school) and going back in 3 weeks for Mardi Gras. It's really a great country and definitely my top contender for moving to if I save up enough money from the U.S.

 

[TulaneUnderdog]

I'll only be worried about the fate of EM Docs when McDonald's and Wendy's are no longer 24 hours open; ERs will surely have to follow then.

 

[TooMuchResearch]

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

I stopped checking the news (other than a few financial things of personal interest) 12 days ago. I take it nothing important has happened?

 

[TheComebacKid]

People seem to be overlooking the bigger elephant in the room: the threat of APP's. The rate of NP's and PA's graduating has increased. I've posted about this in detail in another thread. I'm too tired and lazy to look it up now (finishing a late shift).

People are in complete denial about NP/PA proliferation. This is hands down the biggest threat to our specialty.

Spoke with a physician who works for TeamHealth. They have insider knowledge and are fairly high up in their group. He told me that they have already lost 2 physician slots at his shop and replaced them with NP/PA coverage because of the cost savings. He has to sign more midlevel charts now than ever before and is taking on more liability/risk.

If you think in any shape or from that midlevels are good for our specialty and/or patients, you are a *****.

 

[Birdstrike]

I stopped checking the news (other than a few financial things of personal interest) 12 days ago. I take it nothing important has happened?

Only that we're 11 years, 353 days closer to T H E E N D OF T H E W O R L D

 

[Birdstrike]

People are in complete denial about NP/PA proliferation. This is hands down the biggest threat to our specialty.

Spoke with a physician who works for TeamHealth. They have insider knowledge and are fairly high up in their group. He told me that they have already lost 2 physician slots at his shop and replaced them with NP/PA coverage because of the cost savings. He has to sign more midlevel charts now than ever before and is taking on more liability/risk.

If you think in any shape or from that midlevels are good for our specialty and/or patients, you are a *****.

But will they allow docs to apply for and work the NP/PA jobs?

#EternalOptimist

 

[EctopicFetus]

People are in complete denial about NP/PA proliferation. This is hands down the biggest threat to our specialty.

Spoke with a physician who works for TeamHealth. They have insider knowledge and are fairly high up in their group. He told me that they have already lost 2 physician slots at his shop and replaced them with NP/PA coverage because of the cost savings. He has to sign more midlevel charts now than ever before and is taking on more liability/risk.

If you think in any shape or from that midlevels are good for our specialty and/or patients, you are a *****.

I think it is an issue. The real issue are the CMGs. My group, we decide who we hire and how we staff. Thats what the CMGs do. Work for a CMG and you are part of the problem. See we think they are the issue but their strength only comes from the structure of most EDs. Does an ENT worry about it? No. Why cause the doc is the owner of the practice and controls who does what there. We lost control long ago. I still have some control.

 

[TheComebacKid]

I think it is an issue. The real issue are the CMGs. My group, we decide who we hire and how we staff. Thats what the CMGs do. Work for a CMG and you are part of the problem. See we think they are the issue but their strength only comes from the structure of most EDs. Does an ENT worry about it? No. Why cause the doc is the owner of the practice and controls who does what there. We lost control long ago. I still have some control.

I agree. CMGs are largely here to stay.

Stop supporting ACEP. Stop working for CMGs. Physicians have power in numbers. While I agree CMGs are slowly transitioning into a monopoly making finding jobs in certain markets difficult and forcing the hands of new graduates, we still need to raise hell.

Addressing the CMG problem will in large part address the NP/PA problem. If we don't, because of the pervasiveness of CMGs within our specialty, compared to others such as surgical subspecialties, IM subspecialties, ours will be the first to fall.

This is not just a doom and gloom scenario. It's reality. The positivity in our specialty is based on conditions of today, which I don't deny, make our specialty very appealing to pre-meds and medical students. But I'm talking about the future. I suspect EM salaries will continue to go up until we reach a point of saturation, which is: 1 attending per ED with an army of midlevel foot soldiers to sign off on all of their charts. We have not yet hit that point where we have enough attending supervision for midlevels, but that "critical number" will come a lot sooner now than if we did not have midlevels in our specialty.

I am just incredibly confused as to one point that nobody has ever been able to clearly explain to me. Why aren't we OK with a huge shortage of EM physicians? Who cares if rural EDs are not staffed by a board certified EM physician, and instead are staffed by a FM/IM trained doc? Its better than being staffed by an NP. We still maintain our desirability and can easily go in and take those jobs if we want to. We don't have any prerogative to fulfill the void of EM physicians by increasing our numbers, but for whatever reason, EM feels this pressure to "meet the demand" for EM docs. Urology has had the same number of match spots since the 1980s. They are still highly coveted. At some point we will have so many EM docs coming out into practice, so many NPs/PAs that demand will go away. The demand is not going to keep increasing forever.

I see the advice we give to med students about how "EM pay is only going up" and "we are more in demand now than ever". Hasn't anybody taken a high school economics class?

 

[miacomet]

CMGs are taking over in other areas, too, including anesthesia, hospital medicine, intensive care, and radiology. They are even making inroads with surgery. Not only that, but venture capital is also aggressively acquiring ophtho and derm practices. More and more surgical subspecialists are employed. I agree that fields without an increase in match spots (like urology) are safer bets, but they might increase them tomorrow for all we know.

We don't know what any field will be like in ten years. The safest bets are probably non hospital-based fields like psychiatry where you can have a cash practice with devoted patients and avoid corporate medicine in general, and the other sage advice is to avoid debt (including educational debt) like the plague. If you LOVE EM, then do it; I guess the same goes for any other field.

Note that much of medicine functions like indentured servitude. People would not put up with the night/weekend/holiday issues and general working conditions that EM docs do without significant debt forcing us to work it off. Debt is bondage. Remember that.

 

[Birdstrike]

Note that much of medicine functions like indentured servitude. People would not put up with the night/weekend/holiday issues and general working conditions that EM docs do without significant debt forcing us to work it off. Debt is bondage. Remember that.

There is a lot of truth to this, not only for EM, but all specialties and all the way from training through practice.

First they heap eough tuition debt on you that you can never escape. Next they train you. Then they show you what massive doctor house you can buy to finally "reward" yourself, along with the other doctors' sports cars, country clubs and dinners you "earned." Once you buy into it, they know they've got you by the gonads for as long as they need you.

"Jump, Rover."

Woof, woof!

 

[WilcoWorld]

There is a lot of truth to this, not only for EM, but all specialties and all the way from training through practice.

First they heap eough tuition debt on you that you can never escape. Next they train you. Then they show you what massive doctor house you can buy to finally "reward" yourself, along with the other doctors' sports cars, country clubs and dinners you "earned." Once you buy into it, they know they've got you by the gonads for as long as they need you.

"Jump, Rover."

Woof, woof!

Note that much of medicine functions like indentured servitude. People would not put up with the night/weekend/holiday issues and general working conditions that EM docs do without significant debt forcing us to work it off. Debt is bondage. Remember that.

I'd add that we make our decision to enter a specialty when we're used to paying money (tuition) for the privilege of working our asses off and taking Q3 call. So, the idea of making a few 100k and "only" having to work 14 shifts a month with "only a few nights" sounds positively wonderful by comparison.

Stated differently: beans and rice looks like a gourmet meal after you've been subsisting on gruel for 7 years.

 

[miacomet]

Locums rates are definitely down.
EM has been interesting, but you need an exit strategy, and there just aren't very many.

 

[TooMuchResearch]

Locums rates are definitely down.
EM has been interesting, but you need an exit strategy, and there just aren't very many.

We can apparently get board certified in neurocritical care soon.

 

[miacomet]

We can apparently get board certified in neurocritical care soon.

Great way to slow down....

 

[WilcoWorld]

Great way to slow down....

...and to see better patient outcomes...

 

[miacomet]

We really need some option like onc, ID, psych. Not going to happen.

 

[chudat]

We really need some option like onc, ID, psych. Not going to happen.

Onc? What service would EM physicians provide for onc? asking for my own benefit.

 

[TooMuchResearch]

Onc? What service would EM physicians provide for onc? asking for my own benefit.

We can already do palliative care.