Trends in EM compensation (med students read this)

[sum dude]

For those who want an honest behind scene look on what is going on in EM compensation...we have the perfect storm brewing for trouble. Consider the following PRE-COVID developments:

1) The job market nationally has consolidated over the past 20 years. The majority of clinical EM physicians now work for CMG's. Nothing new
2) HCA and other private hospitals are now starting their own, self-funded residency programs. Many are in rural areas/small hospitals, in hospitals you would not expect to have the wide variety of pathology and commitment to training you would expect to have well-rounded graduates you'd expect from previous years. This was intentional to flood market and lower salaries across the board.
3)Insurers are now the largest employer of physicians in the country. They are buying EM groups. If you think working for Envision is bad, wait till your work for Optum.
4) Same insurers are now seeking legislation which will completely cripple small groups ability to negotiate. If they end balance billing with benchmarks, everyone can expect 20-30% cuts in reimbursement.
5) Insurers and government were shifting patients away from ED, given that they consider it "costly"

Now let's add the Post-Covid World developments:
5) Covid destroyed EM-group revenues across the country. Volume was down 50-60% at max. The majority of places are AT BEST down 20% in volume from their regular monthly averages. Pediatrics, in particular is down 40-50% across the Board.
6) The labor market is as bad as I've ever seen it in medicine. Pretty much any desirable city is not hiring. Pediatric groups are letting people go. Outside of finding part-time work, good luck finding a new job in a desirable city or location. Rural/less desired areas will still have jobs.
7) Many states expanding APP/midlevel scope of practices. Many ED's now have only midlevels staffing. This trend will continue, and push downward pressures on physician reimbursement/hours.
8) Telemedicine is replacing the need for face-face visits in ED. This is further cutting in volume.

What does this mean:
1) For current EM physicians, we've hit the high-water mark in compensation for ED. In real-money terms, we will make less every year (adjusted for inflation). Even not adjusting for inflation, you won't see $300/hr+ like you saw in the forum years ago.
2) New Grads: good luck finding a job. If you get offered a job, take it (Tarzan vine method--swing from one offer to the next--do not say not to an offer unless you are holding on to a job vine, then it's ok to take next offer). You will have zero negotiation power in your contract, despite what your attendings tell you. Expect RVU-based pay where more experienced doctors will drink your milk-shake. You probably won't find a position in a desirable city, and will either have to commute from said city, or work somewhere rural where any slightly complicated patient will need to be transferred (better get real good at ortho, ophtho, urology, gyn etc). If you're Peds EM...I'm sorry, it's going to be rough. You might want to consider UC/part-time/Telemed.
3) Compensation: our pay is going down, gang. Private groups are going to have to come up with non-hospital based revenue streams to survive. Any group with a one hospital contract is likely toast.
4) Med Students: EM is a great field, but likely has jumped the shark in terms of its glory years. It will probably pay closer to what hospitalists make in the future, will be almost all corporate or hospital employee based, and get used to corporate indoctrination where medicine is run like something between the Office, Office Space and Silicon Valley. Eyes Wide Open

Silver lining:
We're moving towards a Specialist-less medical world (thank NP's and PA's for that) where medicine is more heterogeneous and EM can run private clinics, etc. Some entrepreneurial docs who are bold can be "disruptive" and use technology and new businesses to deliver health care, and they will likely bank and change the face of medicine. EM is well-positioned to have grads who capitalize on that thanks to risk-taking, thinking on feet and ability to adapt nature. I suggest grads enhance their business, entrepreneurial and technology skills. Good luck everyone!

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[HemorrhagicShock]

This is a fantastic post. It aligns 100% with my experience as a younger attending. Every single point in the post above is tragically and painfully true.

CMG contracts and contracts, in general, these days are non-negotiable. They have probably 10+ applicants per spot, and any sign of trouble will simply result in a rescinded offer for somebody who is much more willing to bend over and take what they're given.

Tech, entrepreneurial spirit, along with business acumen will be key if one wants to control their work environment and reach those upper echelons of reimbursement. By no means is this easy or guaranteed. Starting one's own private practice clinic is near-impossible even for surgical subspecialists these days, and you have tons of competition with all the PAs and NPs that can open up clinics and offer the same array of services. Cash-based med spas, ketamine clinics, sports meds, urgent cares, and many other types of privately-owned practices are not easy. There are significant startup costs involved, and you definitely won't be living the shift work-life of EM.

But I'd wager that EM will settle into the low $200k/year range, which is a huge insult given the workload, stress, risk, and difficulty of the job. That kind of pay would likely convince me to take a stab at a riskier entrepreneurial endeavor.

 

[ERDude]

This is a fantastic post. It aligns 100% with my experience as a younger attending. Every single point in the post above is tragically and painfully true.

CMG contracts and contracts, in general, these days are non-negotiable. They have probably 10+ applicants per spot, and any sign of trouble will simply result in a rescinded offer for somebody who is much more willing to bend over and take what they're given.

Tech, entrepreneurial spirit, along with business acumen will be key if one wants to control their work environment and reach those upper echelons of reimbursement. By no means is this easy or guaranteed. Starting one's own private practice clinic is near-impossible even for surgical subspecialists these days, and you have tons of competition with all the PAs and NPs that can open up clinics and offer the same array of services. Cash-based med spas, ketamine clinics, sports meds, urgent cares, and many other types of privately-owned practices are not easy. There are significant startup costs involved, and you definitely won't be living the shift work-life of EM.

But I'd wager that EM will settle into the low $200k/year range, which is a huge insult given the workload, stress, risk, and difficulty of the job. That kind of pay would likely convince me to take a stab at a riskier entrepreneurial endeavor.

If this job actually settles to 200k/year for full time, busy ED work then there will need to be a unified approach among ED docs to slow down and work at an actual reasonable pace on shift. Critically ill patients always will and should get immediate attention but beyond that, stable and low acuity patients should wait until all previous documentation and dispo's on existing patients are completed. For 200k/year I'd be willing to see 1.5pph ABSOLUTE MAX and would never, ever rush to pick up a patient that isn't critically ill.

I don't think 200k/year will happen though....perhaps our best inflation-adjusted money days are behind us but I hope there are enough financially secure and late career docs in this field that there would be a mass exodus if the financial bottom fell out.

 

[HemorrhagicShock]

If this job actually settles to 200k/year for full time, busy ED work then there will need to be a unified approach among ED docs to slow down and work at an actual reasonable pace on shift. Critically ill patients always will and should get immediate attention but beyond that, stable and low acuity patients should wait until all previous documentation and dispo's on existing patients are completed. For 200k/year I'd be willing to see 1.5pph ABSOLUTE MAX and would never, ever rush to pick up a patient that isn't critically ill.

I don't think 200k/year will happen though....perhaps our best inflation-adjusted money days are behind us but I hope there are enough financially secure and late career docs in this field that there would be a mass exodus if the financial bottom fell out.

"unified approach among ED docs"



We can't even agree on whether social EM is a real thing, or if gun violence should be a public health issue (my point is not to bring these up as topics here, but as examples of BS that we argue about when there are real specialty-specific problems). We can't even muster an EM militia strong enough to fight the ACGME on the appropriateness of all these new EM programs.

Just forget about real programs like balance billing, inadequate networks, an unfunded EMTALA, CMS budget neutrality, due process, and many other TRULY important issues within our profession. These have been present for YEARS (some decades), and still, we cannot mount any meaningful response.

Rest assured the one constant among physicians is our never-ending desire to throw each other under the bus in order to get ahead. It's ingrained from the second one decides that they want to go to medical school. Intense competition, beat out your rival for that spot, compete compete compete.

Add in a set of current medical students and residents who have no idea of "what it was like" when salaries were 400k/year for a reasonable workload, and all of a sudden the 200k/year seeing 2.5 patients per hour becomes a new normal. Do you honestly think that a group of ED docs would self-limit to 1.5 PPH when they're literally graded on these metrics by the administrators that lord over them? Of course not. Extrapolating that across an entire specialty? Forget it.

What, you don't like these work conditions and pay? Great, we have a steady stream of new young bodies, some with half-a-million in debt, who will work those hours. They will be HAPPY to do that until they burn themselves out. And if for some freak reason that pipeline dries up, and medical students wisen up on the specialty's deep-seated problems, well no big deal because there are streams of foreign grads that would love ANY spot and ANY opportunity to practice in the United States

 

[sum dude]

"unified approach among ED docs"



We can't even agree on whether social EM is a real thing, or if gun violence should be a public health issue (my point is not to bring these up as topics here, but as examples of BS that we argue about when there are real specialty-specific problems). We can't even muster an EM militia strong enough to fight the ACGME on the appropriateness of all these new EM programs.

Just forget about real programs like balance billing, inadequate networks, an unfunded EMTALA, CMS budget neutrality, due process, and many other TRULY important issues within our profession. These have been present for YEARS (some decades), and still, we cannot mount any meaningful response.

Rest assured the one constant among physicians is our never-ending desire to throw each other under the bus in order to get ahead. It's ingrained from the second one decides that they want to go to medical school. Intense competition, beat out your rival for that spot, compete compete compete.

Add in a set of current medical students and residents who have no idea of "what it was like" when salaries were 400k/year for a reasonable workload, and all of a sudden the 200k/year seeing 2.5 patients per hour becomes a new normal. Do you honestly think that a group of ED docs would self-limit to 1.5 PPH when they're literally graded on these metrics by the administrators that lord over them? Of course not. Extrapolating that across an entire specialty? Forget it.

What, you don't like these work conditions and pay? Great, we have a steady stream of new young bodies, some with half-a-million in debt, who will work those hours. They will be HAPPY to do that until they burn themselves out. And if for some freak reason that pipeline dries up, and medical students wisen up on the specialty's deep-seated problems, well no big deal because there are streams of foreign grads that would love ANY spot and ANY opportunity to practice in the United States

I think you underestimate what we can do if everyone on the forum joined up in fighting against the real issues like BB, EMTALA, budget neutrality. We've fought off BB for at least 5 years now, and word on the street is they're going to try to sneak another bill in before end of year. If we all throw our hands up it's over. For now, all those people who complained what do (ACEP, AMA, AAEM, etc) do for me are going to have to join up and fight back further threats. FWIW, I hope current residents realize it was greed and apathy that led us to hear--it's only if they become active in sticking up for physician rights we all can agree on that we have any chance.

 

[Mushdoc]

I think you underestimate what we can do if everyone on the forum joined up in fighting against the real issues like BB, EMTALA, budget neutrality. We've fought off BB for at least 5 years now, and word on the street is they're going to try to sneak another bill in before end of year. If we all throw our hands up it's over. For now, all those people who complained what do (ACEP, AMA, AAEM, etc) do for me are going to have to join up and fight back further threats. FWIW, I hope current residents realize it was greed and apathy that led us to hear--it's only if they become active in sticking up for physician rights we all can agree on that we have any chance.

The majority of EM docs are not on the forum

 

[Frazier]

Good, and sad, post

 

[EctopicFetus]

We wont ever come together. We could and it would be powerful but we NEVER will. I dont think we go to the 200s.. i think the floor for EM pay on average is around 180/hr. I think we will be back there in 5 years. That still gets you in the mid 300s.

Keep in mind the EM CMG /employed salary is based on only 1 thing. Literally 1 thing. Supply/demand.

If BB went thru and you were the only EM doc in the world you could demand quite the salary. CMGs will drive down pay simply because they can. Look at the Denver market. Huge supply.. fixed demand.. payer mix the same. Rates under the $180/hr.

Most current residents are beyond clueless. You have no leverage when you are married with a kid and have 300k+ in debt. You cant stand up for yourself. Your spouse says “I will only live in Denver”. It is what you promised me when I gave up my career for you to go to med school/residency.

So you toil away making 250k a year with your student loans accruing interest at 21k a year In a HCOL area. Yeah you arent standing up for anything. You shut your trap and go work for the “old gold chain” aka DBag and USACS.

 

[alpinism]

We wont ever come together. We could and it would be powerful but we NEVER will. I dont think we go to the 200s.. i think the floor for EM pay on average is around 180/hr. I think we will be back there in 5 years. That still gets you in the mid 300s.

Keep in mind the EM CMG /employed salary is based on only 1 thing. Literally 1 thing. Supply/demand.

If BB went thru and you were the only EM doc in the world you could demand quite the salary. CMGs will drive down pay simply because they can. Look at the Denver market. Huge supply.. fixed demand.. payer mix the same. Rates under the $180/hr.

Most current residents are beyond clueless. You have no leverage when you are married with a kid and have 300k+ in debt. You cant stand up for yourself. Your spouse says “I will only live in Denver”. It is what you promised me when I gave up my career for you to go to med school/residency.

So you toil away making 250k a year with your student loans accruing interest at 21k a year In a HCOL area. Yeah you arent standing up for anything. You shut your trap and go work for the “old gold chain” aka DBag and USACS.

This is very important to understand when discussing the EM job market.

Your average EM resident is usually in a long term relationship and is looking to get married, have kids, and finally settle down after residency. They've spent the last 7+ years sacrificing and putting their life on hold often promising their loved ones to just wait till after graduation and that when everything is said and done they'll have the perfect EM job in the city of their choice. That's why they'll always choose to work these horrible corporate jobs and actively help to destroy the job market for other physicians as long as they can buy their dream home in Austin Texas.

 

[turkeyjerky]

Yeah, the future is pretty bleak. The OP's post should be stickied. Most of us will be working in dumpster-fire ERs, seeing 2.5 pph while "supervising" a team of midlevels seeing another 4 per hour, making 180/hr (really 120/hr + "productivity" in order to offload risk from c-suite). Those of us lucky enough to land w/ an SDG will be at 220-250/hr w/ better conditions. Hospital-employed will be a mixed bag depending on how undesirable the location, but w/ a general trend down.

I'm not quite sure why some people think things are going to get better after covid. This was all a long time coming, the drop in volumes just accelerated it.

This is very important to understand when discussing the EM job market.

Your average EM resident is usually in a long term relationship and is looking to get married, have kids, and finally settle down after residency. They've spent the last 7+ years sacrificing and putting their life on hold often promising their loved ones to just wait till after graduation and that when everything is said and done they'll have the perfect EM job in the city of their choice. That's why they'll always choose to work these horrible corporate jobs and actively help to destroy the job market for other physicians as long as they can buy their dream home in Austin Texas.

But you can't blame them. You're 300k in debt and you need a job. What choice do they have?

 

[betamale]

This is very important to understand when discussing the EM job market.

Your average EM resident is usually in a long term relationship and is looking to get married, have kids, and finally settle down after residency. They've spent the last 7+ years sacrificing and putting their life on hold often promising their loved ones to just wait till after graduation and that when everything is said and done they'll have the perfect EM job in the city of their choice. That's why they'll always choose to work these horrible corporate jobs and actively help to destroy the job market for other physicians as long as they can buy their dream home in Austin Texas.

more ppl coming to Austin?

 

[EctopicFetus]

Yeah, the future is pretty bleak. The OP's post should be stickied. Most of us will be working in dumpster-fire ERs, seeing 2.5 pph while "supervising" a team of midlevels seeing another 4 per hour, making 180/hr (really 120/hr + "productivity" in order to offload risk from c-suite). Those of us lucky enough to land w/ an SDG will be at 220-250/hr w/ better conditions. Hospital-employed will be a mixed bag depending on how undesirable the location, but w/ a general trend down.

I'm not quite sure why some people think things are going to get better after covid. This was all a long time coming, the drop in volumes just accelerated it.


But you can't blame them. You're 300k in debt and you need a job. What choice do they have?

The SDG thing is interesting. It is totally decoupled from most market forces. Wonder why you think pay will settle in there and not $400/hr+. As a counter (my shop wont do this) but lets pretend all the hospitals in town are run with 1 ed doc and 4 MLPs. Most SDGs I know (save 1) are fairly MD heavy. Why wouldn’t they replace doc shifts with MLPs and just bank that profit. Perhaps pay could be $800/hr. I mean if I ”worked” and had 4 MLPs reporting to me I would make at least that much.

 

[blue.jay]

more ppl coming to Austin?

What is so desirable about Austin? I know lot of tech companies moving there. TX has no state income tax. Makes sense for tech workers but why do doctors want to move there? I've visited once but didn't find ton of stuff to do unlike Colorado, Oregon, Washington or Arizona.

 

[turkeyjerky]

The SDG thing is interesting. It is totally decoupled from most market forces. Wonder why you think pay will settle in there and not $400/hr+. As a counter (my shop wont do this) but lets pretend all the hospitals in town are run with 1 ed doc and 4 MLPs. Most SDGs I know (save 1) are fairly MD heavy. Why wouldn’t they replace doc shifts with MLPs and just bank that profit. Perhaps pay could be $800/hr. I mean if I ”worked” and had 4 MLPs reporting to me I would make at least that much.

I just see more downward pressure from payors in the future. Plus ensuing bans on balance billing (although this is far less important to SDGs than CMGs). I mean, I'm sure that some money-minded SDGs will increase their use of midlevels in order to protect income, but imho this leads to a pretty miserable practice environment. (Some SDGs will probably pivot to hiring more employee tract physicians at CMG rates too, but then they really cease to be a SDG).

Regardless of whether or not reimbursement decreases or not, I definitely see a two-tier market in the future. The problem for most docs is that nearly all available jobs will be CMGs.

 

[skougess]

What is so desirable about Austin? I know lot of tech companies moving there. TX has no state income tax. Makes sense for tech workers but why do doctors want to move there? I've visited once but didn't find ton of stuff to do unlike Colorado, Oregon, Washington or Arizona.

I say this as a millennial myself: Millennials LOVE picking random nothing-special cities and making them hot-spot must-live destinations for discernibly no reason.

Come live in Seattle where it’s.....cold, overcast, and rainy every day?

 

[Apollyon]

I say this as a millennial myself: Millennials LOVE picking random nothing-special cities and making them hot-spot must-live destinations for discernibly no reason.

Come live in Seattle where it’s.....cold, overcast, and rainy every day?

I love this joke:

How did the hipster burn his mouth?

He sipped his coffee before it was cool!

 

[turkeyjerky]

What is so desirable about Austin? I know lot of tech companies moving there. TX has no state income tax. Makes sense for tech workers but why do doctors want to move there? I've visited once but didn't find ton of stuff to do unlike Colorado, Oregon, Washington or Arizona

I dunno what you guys are talking about. Austin's a fun city. Sounds like you're more into outdoors stuff, so I could see it not being ideal though (although it's not that bad in this regard either). Traffic is insane now though and its getting expensive.

 

[skougess]

I dunno what you guys are talking about. Austin's a fun city. Sounds like you're more into outdoors stuff, so I could see it not being ideal though (although it's not that bad in this regard either). Traffic is insane now though and its getting expensive.

Austin is a fun city but so are most small to mid size cities in 2020. People weirdly fixate on a handful of random ones for reasons that escape me.

 

[Fox800]

What is so desirable about Austin? I know lot of tech companies moving there. TX has no state income tax. Makes sense for tech workers but why do doctors want to move there? I've visited once but didn't find ton of stuff to do unlike Colorado, Oregon, Washington or Arizona.

Great restaurants, essentially non-existent winters, lots of outdoorsy things to do, attractive people, health-conscious residents, progressive mindset (compared to the rest of TX), booming economy/real estate market, no snow, great music scene (pre-COVID), no state income tax...

It totally sucks...don't move there.

 

[RustedFox]

I say this as a millennial myself: Millennials LOVE picking random nothing-special cities and making them hot-spot must-live destinations for discernibly no reason.

Come live in Seattle where it’s.....cold, overcast, and rainy every day?

Yep.

I have one toe in with the millennial crowd in terms of birthdate.
They love that nonsense.
"Asheville is cool because... We found a place with a low COL, so we all moved there and opened vape shops and CBD novelty boutiques."

Now, it sucks because "hipsters".

 

[bravotwozero]

I say this as a millennial myself: Millennials LOVE picking random nothing-special cities and making them hot-spot must-live destinations for discernibly no reason.

Come live in Seattle where it’s.....cold, overcast, and rainy every day?

I'd take the cold, overcast, rainy weather over 100 degree humid sauna 6-7 months out of the year in south TX anyday. Have fun trying to do anything besides hibernating indoors in that weather. But the crappy wages, taxes, and high cost of living in Seattle....not so much.

 

[RustedFox]

I'd take the cold, overcast, rainy weather over 100 degree humid sauna 6-7 months out of the year in south TX anyday. Have fun trying to do anything besides hibernating indoors in that weather. But the crappy wages, taxes, and high cost of living in Seattle....not so much.

Same here in FL.
There's two seasons: "Summer" and "August".
August lasts 188 days.

 

[RustedFox]

Same here in FL.
There's two seasons: "Summer" and "August".
August lasts 188 days.

I've said this before, too - but it bears repeating.
There's two seasons in Florida - "Jungle" and "Snowbird".
You don't want to go out during either.

I used to play golf. Was pretty good.
Playing golf in the summer here requires two changes of clothes and a new golf glove every other hole, as you'll sweat thru everything. Sure, its cheap (29 bucks for 18 holes with cart), but... heatstroke.
Playing golf in the winter here requires at least $129 dollars and a (normally) four-hour round will take 6 hrs : 45 mins because the seniors can't remember where they are or what they're doing.

Someone bump "RustedFox Rants: Snowbirds" for a laugh.

 

[EctopicFetus]

I just see more downward pressure from payors in the future. Plus ensuing bans on balance billing (although this is far less important to SDGs than CMGs). I mean, I'm sure that some money-minded SDGs will increase their use of midlevels in order to protect income, but imho this leads to a pretty miserable practice environment. (Some SDGs will probably pivot to hiring more employee tract physicians at CMG rates too, but then they really cease to be a SDG).

Regardless of whether or not reimbursement decreases or not, I definitely see a two-tier market in the future. The problem for most docs is that nearly all available jobs will be CMGs.

I agree. Insurers may increase pressure but thats been the discussion for so long. CMG contracts are a fair bit better than most SDG contracts. A smart SDG lets that go in their favor. Typical MLP profit is well over 100%. Meaning if I pay my MLP 100k a year i will collect over 200k from their work. It doesnt take a genius to find a way to profit off of this. Key is owning those contracts.

 

[blue.jay]

I agree. Insurers may increase pressure but thats been the discussion for so long. CMG contracts are a fair bit better than most SDG contracts. A smart SDG lets that go in their favor. Typical MLP profit is well over 100%. Meaning if I pay my MLP 100k a year i will collect over 200k from their work. It doesnt take a genius to find a way to profit off of this. Key is owning those contracts.

Hey! That's the boomer doc business strategy.

 

[EctopicFetus]

Hey! That's the boomer doc business strategy.

Yep and they leave the rest behind. It’s sad.

 

[CajunMedic]

I've said this before, too - but it bears repeating.
There's two seasons in Florida - "Jungle" and "Snowbird".
You don't want to go out during either.

When I interviewed in Wheeling, WV the first time, I was asked "Why would a guy from Louisiana want to come here?"
My Reply: "I wanted to live somewhere with 4 seasons that weren't summer, more summer, hurricane, and LSU football..."

Any thoughts of going back to the deep south to live before retirement were killed by this last hurricane season. I'll live here and pick up a few shifts in MS or LA

 

[Brigade4Radiant]

Weather is very important for picking a location, if you want to be outside and near a happening city that is reasonable. Also some factors such as being near family is very important for child care and support. When you are married its not like you're the only one making the decision on where to move.

When I was single I used to think of it as a curse but since getting out of residency it allowed me to easily pick a place I wanted with good compensation. Now I an pick up different avenues that can allow me to make money outside of EM since jobs are hard to come by.

Most EM groups in my area have changed from hourly to RVU. So don't expect to slow down when compensation drops. Infact they got a new grad from New York at my PRN shop (I work in the south she was just able to get a job in September her husband is still in New York) They offered her hourly to get her here then changed it up to a new compensation model in January from 260 hourly to 120 hour plus RVU. Several group emails occurred but ultimately the director said take it or leave it they have a lot of applicants.

For Premeds I would recommend going to be an NP or PA. They are the future of healthcare it only takes 2 years as an NP you can just do online while working so you don't have to get into debt. You also can go into ortho, derm, plastics, EM, psych so when a specialty goes under you can whether the storm.

Its sad but corporate doesn't care about all the training and crap we had to go through.

 

[BoardingDoc]

Weather is very important. When I was single in med school and residency are used to think of it as a curse but was really a blessing because I could work a lot of jobs and still be in my early 30s getting rid of that and then trying new avenues so when EM comes falling down I can pick my spouse and have a family I won’t be as stressed as the avg ED doctor.

Also expect nearly every job to be our view so you have to pick up patients. CMG is our hip to the fact that you can slow down so now in the south I’m now in three group switched from hourly to 120 an hour plus our RVU base.

Really this is for premeds if you’re interested in healthcare I wouldn’t recommend going NP or PA route. That way you have flexibility to go to ED to ortho to cosmetics to psych takes less years and they are market forces that simply make you more profitable.

Was this written with talk to text? This was super challenging to read and a bunch of it makes no sense or states the exact opposite of what I think you were trying to say.

 

[Brigade4Radiant]

Was this written with talk to text? This was super challenging to read and a bunch of it makes no sense or states the exact opposite of what I think you were trying to say.

Sorry about that yep in bed talk to text. I edited my post for clarity.

 

[chocomorsel]

Great restaurants, essentially non-existent winters, lots of outdoorsy things to do, attractive people, health-conscious residents, progressive mindset (compared to the rest of TX), booming economy/real estate market, no snow, great music scene (pre-COVID), no state income tax...

It totally sucks...don't move there.

It sucks for a physician job prospect and pay thing. I certainly know the anesthesia 5 year “partnership“ tracks with crappy pay working for an AMC ain’t gonna work for a lot of people.

 

[southerndoc]

Sorry about that yep in bed talk to text. I edited my post for clarity.

I reread it thinking "what's wrong with it?" Being a mod, I was able to read your original post. Thanks for editing it. Definitely makes more sense now!

 

[blue.jay]

For Premeds I would recommend going to be an NP or PA. They are the future of healthcare it only takes 2 years as an NP you can just do online while working so you don't have to get into debt. You also can go into ortho, derm, plastics, EM, psych so when a specialty goes under you can whether the storm.

Its sad but corporate doesn't care about all the training and crap we had to go through.

Not completely true. Could have been a good career if there is better quality and restriction in NP school admission. They are exploding like tumor cells and they will soon destroy their own job market. NP jobs are already heavily saturated in many cities where RN pay is better than NP.

 

[Fox800]

It sucks for a physician job prospect and pay thing. I certainly know the anesthesia 5 year “partnership“ tracks with crappy pay working for an AMC ain’t gonna work for a lot of people.

Yep, the job market sucks because new grads want to be there.

 

[theSmurfette]

PGY2 here. I’m here thinking, y’all can have the cities. I have no desire to work in a city with >100k people. And definitely won’t live in the city.

I WANT to work in the “undesirable” parts of the country as y’all call them. The places y’all find abhorrent are exactly what I want. I’ll take the heat and humidity over snow and cold any day of the week.

 

[turkeyjerky]

PGY2 here. I’m here thinking, y’all can have the cities. I have no desire to work in a city with >100k people. And definitely won’t live in the city.

I WANT to work in the “undesirable” parts of the country as y’all call them. The places y’all find abhorrent are exactly what I want. I’ll take the heat and humidity over snow and cold any day of the week.

You're missing the point. The trends the OP noted are universal. Huntsville is the new Denver.

 

[ERDude]

You're missing the point. The trends the OP noted are universal. Huntsville is the new Denver.

Those trends may be increasing but they aren't universal. There are major metro areas with no CMG presence.

 

[theSmurfette]

You're missing the point. The trends the OP noted are universal. Huntsville is the new Denver.

I don’t think I am. I was raised lower middle class and think $200/hr is insane money. More money that I can imagine honestly.

I also went into this thinking I was going to get $200-225/hour. I’m living very comfortably on my resident salary (plus my husband’s salary) with lots of nice things. I’m married, 3 kids and late 30’s. All I want is 50 acres and a house after residency.

Y’all think eww Huntsville but they also have NASA and all the affiliated companies there. Lots of brain power concentrated in that city.

 

[Arcan57]

The SDG thing is interesting. It is totally decoupled from most market forces. Wonder why you think pay will settle in there and not $400/hr+. As a counter (my shop wont do this) but lets pretend all the hospitals in town are run with 1 ed doc and 4 MLPs. Most SDGs I know (save 1) are fairly MD heavy. Why wouldn’t they replace doc shifts with MLPs and just bank that profit. Perhaps pay could be $800/hr. I mean if I ”worked” and had 4 MLPs reporting to me I would make at least that much.

Cause if they replaced doc with MLPs they'd lose the contract.

 

[turkeyjerky]

I don’t think I am. I was raised lower middle class and think $200/hr is insane money. More money that I can imagine honestly.

I also went into this thinking I was going to get $200-225/hour. I’m living very comfortably on my resident salary (plus my husband’s salary) with lots of nice things. I’m married, 3 kids and late 30’s. All I want is 50 acres and a house after residency.

Y’all think eww Huntsville but they also have NASA and all the affiliated companies there. Lots of brain power concentrated in that city.

Ugh. Still missing the point.

 

[Brigade4Radiant]

Yes EM docs will still make six figures but compare that to other six figure jobs. We literally deal with life or death decisons and the risk of getting sued. You also have to factor in the training time and the debt that had to go into this.

RN working residency hours then getting an MBA can easily make six figures

 

[chocomorsel]

PGY2 here. I’m here thinking, y’all can have the cities. I have no desire to work in a city with >100k people. And definitely won’t live in the city.

I WANT to work in the “undesirable” parts of the country as y’all call them. The places y’all find abhorrent are exactly what I want. I’ll take the heat and humidity over snow and cold any day of the week.

And in those smaller cities you will be appreciated and paid accordingly. And you won’t have to claw one another for jobs. I just had this same discussion with a couple of ER guys out in West Texas. One had never worked in his city because it pays crap (Austin) and the other saying that they haven’t hired anyone in five years and they are cutting everyone’s hours and pretty soon the pay is gonna go down for them he thinks (Dallas). So they are working Covid to supplement their income while midsize to smaller cities can’t recruit or find physicians.

I am the exact same way. Only live in my city for familial assistance with an elderly parent. Otherwise smaller 500k town or less and I am good. Don’t need fancy restaurants, museums or football teams.

Be careful though. You can go too small and not get paid that well.

 

[RustedFox]

You're missing the point. The trends the OP noted are universal. Huntsville is the new Denver.

(See above discussion about Millennials and hipsters)

We got sick of the hipster nonsense in Asheville, so we took a trip to Chattanooga.
Where, much to our dismay, we found people saying "Chattanooga is the new Asheville".
Thanks, hipsters.

 

[chocomorsel]

I don’t think I am. I was raised lower middle class and think $200/hr is insane money. More money that I can imagine honestly.

I also went into this thinking I was going to get $200-225/hour. I’m living very comfortably on my resident salary (plus my husband’s salary) with lots of nice things. I’m married, 3 kids and late 30’s. All I want is 50 acres and a house after residency.

Y’all think eww Huntsville but they also have NASA and all the affiliated companies there. Lots of brain power concentrated in that city.

While I agree with some of what you are saying, it’s naive people like you that make it suck for everyone else.
Can you not see that in a practice that literally deals with life and death that in the past and maybe now is used to earning $300/hr+ how $200 is lowball?
To you it’s an insane amount like you call it. But if that money is 1/3 less than it was even a year ago, that’s a problem.
Are other fields getting their pay cut like ours in medicine?
You gotta look at the whole picture. And look at how much money they are making off of you when they make you see a bunch of patients an hour.

 

[RustedFox]

While I agree with some of what you are saying, it’s naive people like you that make it suck for everyone else.
Can you not see that in a practice that literally deals with life and death that in the past and maybe now is used to earning $300/hr how $200 is lowball?
To you it’s an insane amount like you call it. But if that money is 1/3 less than it was even a year ago, that’s a problem.
Are other fields getting their pay cut like ours in medicine?
You gotta look at the whole picture. And look at how much money they are making off of you when they make you see a bunch of patients an hour.

Add on to that the fact that the MBAs and other losers who can't medicine are making far more than you while you're awake at 3am, dealing with nonsense patients and all their abuse, absorbing all the liability, and waking up to phone calls/emails about how you're not efficient enough, or that the patient wasn't happy enough, or whatever, and you begin to see just what kind of insult it is to be paid below a certain level.

It wasn't long ago on here that some resident asked: "Well, if [X] is too much, what percent do you think is fair for administration to take?" (in response to some question about how the money is "split" between management and rank-and-file docs). Its exactly statements like this that show that the kids have zero idea how they're being screwed by the fat vasculopaths that call themselves admins.

Psst. If you're reading this, and you're still thinking in terms of splitting percentages, you're already too far gone.

 

[theSmurfette]

While I agree with some of what you are saying, it’s naive people like you that make it suck for everyone else.
Can you not see that in a practice that literally deals with life and death that in the past and maybe now is used to earning $300/hr+ how $200 is lowball?
To you it’s an insane amount like you call it. But if that money is 1/3 less than it was even a year ago, that’s a problem.
Are other fields getting their pay cut like ours in medicine?
You gotta look at the whole picture. And look at how much money they are making off of you when they make you see a bunch of patients an hour.

In my neck of the woods, semi-rural mid-South I’ve never heard of anyone being paid $300+ unless you’re a partner at the big place that’s RVU only.

Look, I get what you’re saying. I’m not naive. I would be offended too is my salary was dropping by 1/3. I just haven’t heard of that happening around here. Our PGY3’s are being offered a good salary for next year. For our area. And it hasn’t gone down. All of our attendings have been in both academics and the most of the community places around here so they know what the going rate is.

I’m happy with where my life is going. I’ll end up getting $200 or so an hour for a small rural place that usually gets FM/IM because they can’t afford to pay $300 for the city dwellers. And I’m ok with that. I went to medical school solely to be an ER doc. I never wanted to do anything else. It’s what I’m getting to do and I’m happy with that.

 

[Lexdiamondz]

I don’t think I am. I was raised lower middle class and think $200/hr is insane money. More money that I can imagine honestly.

I also went into this thinking I was going to get $200-225/hour. I’m living very comfortably on my resident salary (plus my husband’s salary) with lots of nice things. I’m married, 3 kids and late 30’s. All I want is 50 acres and a house after residency.

Y’all think eww Huntsville but they also have NASA and all the affiliated companies there. Lots of brain power concentrated in that city.

Bro, I grew up without indoor toilets in a "****hole country". My PGY4 salary is the most money anyone in my family has ever made. After 4 years of residency, the prospect of dealing with people's first world problems and largely lifestyle-inflicted ailments for <200/hr is repugnant to me. We all value different things though, so I can't knock another guys' happiness.

 

[sloh]

I lived off ramen and had 3 roommates throughout college and med school. I then lived off 50-60 k/year in residency and was barely able to put any money into retirement. I'm happy with anything over 100 k/year as an attending. I have passion for medicine!

 

[Rekt]

Bro, I grew up without indoor toilets in a "****hole country". My PGY4 salary is the most money anyone in my family has ever made. After 4 years of residency, the prospect of dealing with people's first world problems and largely lifestyle-inflicted ailments for <200/hr is repugnant to me. We all value different things though, so I can't knock another guys' happiness.

It just makes her look kind of stupid. I also grew up with nothing, but accepting ridiculously low salaries is actually just very selfish and hurts the entire specialty.

 

[theSmurfette]

I lived off ramen and had 3 roommates throughout college and med school. I then lived off 50-60 k/year in residency and was barely able to put any money into retirement. I'm happy with anything over 100 k/year as an attending. I have passion for medicine!

Never said any of that. I work to live, not live to work. I just don’t feel the need to make $500k/year to feel accomplished.

Never had a roommate other than the one I married. Or I guess the ones I made. And I don’t like ramen.