Valley Emergency Physician docs plan walk out for tomorrow

[EctopicFetus]

Link?

Em docs on Facebook.

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[HemorrhagicShock]

QFT

I completely agree and I would be willing to take the risk of being villified and hated for the greater good

Bingo. And here's the thing a lot of the rank and file physicians across all specialties don't realize.

We are already hated and vilified by a good portion of the nation

It's time to spend whatever social and political capital we have left, otherwise this descent will only accelerate!

 

[bravotwozero]

Bingo. And here's the thing a lot of the rank and file physicians across all specialties don't realize.

We are already hated and vilified by a good portion of the nation

It's time to spend whatever social and political capital we have left, otherwise this descent will only accelerate!

But does this necessarily have to mean playing ‘employment chicken’ by striking?

There might be more effective ways to force change. We do live in the age of social media, things go viral in no time. Early on in the pandemic, a few docs got canned for raising concerns about PPE, or even bringing in their own. That drew a lot of bad press for their employers.

Otherwise, organized labor does not have a good track record in this country when going up against organized capitol. This is going to hold true for us despite the fact we got EPs in public office.

 

[RustedFox]

So, today was the planned walkout.

Anyone know what actually happened?

 

[GassYous]

So, today was the planned walkout.

Anyone know what actually happened?

I will take a wild guess and predict that the employer didn't give a f and nothing changed

 

[HemorrhagicShock]

But does this necessarily have to mean playing ‘employment chicken’ by striking?

There might be more effective ways to force change. We do live in the age of social media, things go viral in no time. Early on in the pandemic, a few docs got canned for raising concerns about PPE, or even bringing in their own. That drew a lot of bad press for their employers.

Otherwise, organized labor does not have a good track record in this country when going up against organized capitol. This is going to hold true for us despite the fact we got EPs in public office.

Not at all. It's not a necessary part of the equation. However, I don't think "OMG what will people think of us?!?" should continue to be a reason to avoid collective action (whether it's striking or whatever). All you need to do is look at the comment section of any online article about healthcare to know how people feel about physicians these days (hint: it's not good)

Regardless, these are all pipe dreams and fantasies. We can't even agree within our own specialty (AAEM vs. ACEP etc.), so just forget about inter-specialty collective action. When is the last time an orthopod cared about the plight of the primary care physician? Do you think the hospitalist gives a crap about private equity takeover of EM? When has a neurosurgeon cared about anything besides neurosurgery?

There is zero hope for medicine because physicians are all lone wolves. They're built this way from day one (competition to get into medical school, residency, jobs and so forth). Even in private practice, the ENT is in competition with the ENT on the other side of town.

So yea, your ultimate point that organized labor doesn't have a good track record is a great one. In our case, we can't even get our labor organized!

 

[Vandalia]

Not at all. It's not a necessary part of the equation. However, I don't think "OMG what will people think of us?!?" should continue to be a reason to avoid collective action (whether it's striking or whatever). All you need to do is look at the comment section of any online article about healthcare to know how people feel about physicians these days (hint: it's not good)

Comment sections of articles is the absolute last place to look to determine any fact or draw any conclusion.

Actual surveys show that physicians are in the top 2 or 3 most respected professions.

 

[RustedFox]

Comment sections of articles is the absolute last place to look to determine any fact or draw any conclusion.

Actual surveys show that physicians are in the top 2 or 3 most respected professions.

Funny, I don't feel so respected.

 

[HemorrhagicShock]

Comment sections of articles is the absolute last place to look to determine any fact or draw any conclusion.

Actual surveys show that physicians are in the top 2 or 3 most respected professions.

Even if this is the case (I honestly don't believe the people responding to those surveys actually respect physicians, they just think it's a profession that SHOULD be respected and thus answer accordingly) they're likely thinking of their specialist or some surgeon that electively operated on their thorn-in-the-side problem, and not the ER doc.

Nobody respects the ER doc (including other ER docs)

 

[EctopicFetus]

Even if this is the case (I honestly don't believe the people responding to those surveys actually respect physicians, they just think it's a profession that SHOULD be respected and thus answer accordingly) they're likely thinking of their specialist or some surgeon that electively operated on their thorn-in-the-side problem, and not the ER doc.

Nobody respects the ER doc (including other ER docs)

Totally true. If you want to be liked and respected be a subspecialty surgeon or an underpaid pcp. The Ed docs have always been the whipping boys of medicine. No one likes us. No one wants to do our ****ty job and everyone thinks we are overpaid. It’s gonna be hard to get empathy when last I checked avg em compensation is like 380k a year. Plenty of people will do almost anything for that $$$ and not complain. They don’t give 2 💩 about your sacrifices or anything else.

 

[The kitchen sink]

Not at all. It's not a necessary part of the equation. However, I don't think "OMG what will people think of us?!?" should continue to be a reason to avoid collective action (whether it's striking or whatever). All you need to do is look at the comment section of any online article about healthcare to know how people feel about physicians these days (hint: it's not good)

Regardless, these are all pipe dreams and fantasies. We can't even agree within our own specialty (AAEM vs. ACEP etc.), so just forget about inter-specialty collective action. When is the last time an orthopod cared about the plight of the primary care physician? Do you think the hospitalist gives a crap about private equity takeover of EM? When has a neurosurgeon cared about anything besides neurosurgery?

There is zero hope for medicine because physicians are all lone wolves. They're built this way from day one (competition to get into medical school, residency, jobs and so forth). Even in private practice, the ENT is in competition with the ENT on the other side of town.

So yea, your ultimate point that organized labor doesn't have a good track record is a great one. In our case, we can't even get our labor organized!

Another post that I have QFT

I couldn’t agree more. I look around and I only see division.

Initially I thought maybe a catastrophic event would be send a signal to physicians that radical change was needed across a broken system— but it didn’t do much. 5 million dead worldwide (gross underestimate, I know) and things are ****tier than ever in healthcare.

Maybe 5 million physicians needed to pass away for the impact to be felt, IDK anymore

I dont have a solution but what is happening to physicians is a microcosm of American society as a whole: me me me first, f everyone else and forget the wellbeing of future generations too, the rich v poor divide (super subspecialist surgeon or cosmetic dermatology raking in 800K and then the rest of us grunts, rampant tribalism, lack of interdisciplinary cooperation between specialties.)
Of course all these observations are just my own.

I sound like a pessimist but trust me im mostly just a realist 🤣

 

[The kitchen sink]

Totally true. If you want to be liked and respected be a subspecialty surgeon or an underpaid pcp. The Ed docs have always been the whipping boys of medicine. No one likes us. No one wants to do our ****ty job and everyone thinks we are overpaid. It’s gonna be hard to get empathy when last I checked avg em compensation is like 380k a year. Plenty of people will do almost anything for that $$$ and not complain. They don’t give 2 💩 about your sacrifices or anything else.

Is 380K too high or too low in your opinion? Or just right

 

[namethatsmell]

Not really a fair comparison given how pre-COVID y'all were averaging 4X or more per hour than nurses.

People also really like/trust nurses. They're the main point of patient contact, patient centered and all the other stuff the nursing PR stuff goes on about.

Your first statement is certainly true regarding wage discrepancy. But it doesn't seem to me to explain the difference in public opinio. Why aren't minor leaguers more loved by the public vs pro all stars? Flight attendants vs pilots?

Your 2nd statement is true too, but the question in why?

When it come to the "heart of a nurse" and being "patient-centered," much of this comes down to listening to patients and talking to them like real people. Which most non-jerkface doctors are capable of doing, and which plenty of actual nurses cannot do at all.

And you're spot on re: nursing PR stuff, they have us lapped many time over in that regard.

 

[EctopicFetus]

Is 380K too high or too low in your opinion? Or just right

Depends. Hours? Volume? Etc. Imo em docs should earn about $150/pt plus a floor of $200/hr.

 

[turkeyjerky]

I just saw that post by the ACEP prez. Jesus F’ing Christ—cannot believe she compared the docs standing up to usacs to covid denying urine drinkers.

 

[nimbus]

For those who don’t know, county employed floor nurses who work at SCVMC make 300-400K+. The county employed Anesthesiologists make 600-800k+. It’s no wonder the ED staff want the EM Docs to be county employed too. It would be expensive but it would also bring stability to the department. I doubt anyone can afford to live there with what USACS pays, unless they have a tech spouse.

 

[VA Hopeful Dr]

Your first statement is certainly true regarding wage discrepancy. But it doesn't seem to me to explain the difference in public opinio. Why aren't minor leaguers more loved by the public vs pro all stars? Flight attendants vs pilots?

Your 2nd statement is true too, but the question in why?

When it come to the "heart of a nurse" and being "patient-centered," much of this comes down to listening to patients and talking to them like real people. Which most non-jerkface doctors are capable of doing, and which plenty of actual nurses cannot do at all.

And you're spot on re: nursing PR stuff, they have us lapped many time over in that regard.

The difference in income isn't related to how much they like different fields, its related to how much sympathy people have if you strike. To keep with baseball, remember how much damage the 94 strike did? Pre-COVID in my area most RNs were making $30-ish/hour. That's pretty close to what the median income is so people have sympathy because they can relate to making that much and working very hard. Contrast that to $200/hour (or more). Most people would kill to make that much money. So we can complain about various things about our working conditions that are unfair, unsafe, whatever but the average person is just going to say "For $200/hour I'd put up with all of that".

As for the second, because most doctors don't is my guess. There's also the power differential. We're basically in charge of patients and most people don't like someone else having that much power over them. If you refuse to give a patient antibiotics, they're going to be mad at you while the nurse can offer sympathy since its not their decision.

 

[RustedFox]

So..

What happened with the walkout?

 

[larpleston]

So..

What happened with the walkout?

Turmoil in San Jose ED: Overworked, Unhappy Staff Stage Walkout

Yes, the pandemic is still causing havoc, but is a new doc staffing group making things worse?

www.medpagetoday.com

The walkout happened and apparently Feb 6th is when the contract either expires or is renewed. Interesting that ACEP (and by extension USACS) is so worried about these arrangements seeing the light of day. For all the talk about how physicians are viewed in the public eye, the people with actual power seem to perceive that public knowledge of the PE invasion of emergency medicine is an existential threat. Maybe we should listen to our opponent when they tell us what hurts them and not worry about the general publics potential lack of sympathy to our cause.

 

[LibBum]

I worked with Patlovany when I was a scribe in San Antonio, crazy to see he's high up on the dark side. His responses align with my prior impression of him from years ago, some things don't change. Interesting world...

 

[Birdstrike]

[Maybe we should listen to our opponent when they tell us what hurts them and not worry about the general publics potential lack of sympathy to our cause.

There never has been, and there never will be, any “sympathy for the physician cause” by the general public. The general public is interested in what physicians can provide from them. They’re not, and never will be, concerned with what they can provide for physicians.

Because we spend our life’s work worrying about what’s best for patients, doesn’t mean patients spend a minute worrying about what’s best for us.

Such “sympathy for the cause of physicians” by the general public should never be a factor in physician strategizing. It’s imaginary, wishful thinking.

 

[namethatsmell]

There never has been, and there never will be, any “sympathy for the physician cause” by the general public. The general public is interested in what physicians can provide from them. They’re not, and never will be, concerned with what they can provide for physicians.

Because we spend our life’s work worrying about what’s best for patients, doesn’t mean patients spend a minute worrying about what’s best for us.

Such “sympathy for the cause of physicians” by the general public should never be a factor in physician strategizing. It’s imaginary, wishful thinking.

Yes. This is exactly it. Was what I trying to get at with how nurses striking clearly announced to the public that they have human needs just like patients and also highlights that they can't/shouldn't be taken for granted.

Only when the equation of us caring about the public >>>> the public caring about us is paused in a very public way with actions (not words)...only then will perhaps the script somewhat shift. But that will probably never happen.

 

[bronx43]

Yes. This is exactly it. Was what I trying to get at with how nurses striking clearly announced to the public that they have human needs just like patients and also highlights that they can't/shouldn't be taken for granted.

Only when the equation of us caring about the public >>>> the public caring about us is paused in a very public way with actions (not words)...only then will perhaps the script somewhat shift. But that will probably never happen.

Sympathy should never be pursued as a primary strategic goal. It's AT BEST ornamental after you make a power move. The problem with physicians has always been (and will always be) our inability to make such a power move on a united front. Until enough of us are willing to risk our comfortable position in life, we have no place at the big kids' table.

 

[namethatsmell]

Sympathy should never be pursued as a primary strategic goal. It's AT BEST ornamental after you make a power move. The problem with physicians has always been (and will always be) our inability to make such a power move on a united front. Until enough of us are willing to risk our comfortable position in life, we have no place at the big kids' table.

Never said sympathy was the goal. My point is that actual action is the only chance of things changing for the better.

Have you ever worked in a rural or very underserved area? Doctors have far more power/control/respect due to the supply : demand mismatch. Kinda like a sneak peak at what conditions could be possible if a (unlikely) unifying movement/organization of doctors ever materialized.

 

[bronx43]

Never said sympathy was the goal. My point is that actual action is the only chance of things changing for the better.

Have you ever worked in a rural or very underserved area? Doctors have far more power/control/respect due to the supply : demand mismatch. Kinda like a sneak peak at what conditions could be possible if a (unlikely) unifying movement/organization of doctors ever materialized.

100% true.

This actually goes to show just how much doctors want the “good life,” and how little we are willing to sacrifice. Most of us wouldn’t even move to an area with less amenities let alone risk our upper middle class income by threatening to quit as part of a collective.

 

[The kitchen sink]

100% true.

This actually goes to show just how much doctors want the “good life,” and how little we are willing to sacrifice. Most of us wouldn’t even move to an area with less amenities let alone risk our upper middle class income by threatening to quit as part of a collective.

Begs the question though: what happens if our upper middle class income disappeared?

 

[deleted941485]

Begs the question though: what happens if our upper middle class income disappeared?

Nothing really happens you become an unremarkable pleb clipping coupons, taking ****ty vacations, and living in homes contructed 70 years ago that also look like it in crappy locales with equally questionable friend pool

You basically just become like the rest of America, broke, poor, unremarkable, and a target demographic for presidential campaign callers. I lived this life…it’s painfully boring. You literally go nowhere.

Honestly medicine is interesting but not so interesting that the loss of that income would make me stay. I would just stop caring.

 

[bronx43]

Begs the question though: what happens if our upper middle class income disappeared?

By then it’s too late. The war is lost. When/if metro hospitals siege and lay waste to physician salaries, MGMA data would reflect this and drag down even rural pay.

The fact of the matter is that the barbarians are at the gates, and physicians are just dropping our weapons and letting them in with not an ounce of resistance.

 

[EctopicFetus]

By then it’s too late. The war is lost. When/if metro hospitals siege and lay waste to physician salaries, MGMA data would reflect this and drag down even rural pay.

The fact of the matter is that the barbarians are at the gates, and physicians are just dropping our weapons and letting them in with not an ounce of resistance.

There is nothing to fight about. The war was lost long Ago. We gave them our plunder for the hope they would continue to allow us to work their fields. Now the ages for working their fields is about to collapse. Little to nothing left to do. What are we defending ? our ****ty position in the house of medicine? Proving to number crunchers we are “better” than Jenny mcjennyson and her online medical degree? No one cares one iota. We are trying to fight a fight we find interesting not the one our owners think matters. It’s a lost cause. I’m sad to say so but it’s game over. It’s now a matter of how terrible it will be. Will the hourly rate drop to 160 or 140. Im not getting all hot and bothered by that. We sad idly on our hands while taking L after L On issues that impacted our pay much more. It’s game over now kids. Find a plan b. Let the idiots who don’t listen suffer. Be better than the idiots. Most wont be.

 

[WilcoWorld]

Nothing really happens you become an unremarkable pleb clipping coupons, taking ****ty vacations, and living in homes contructed 70 years ago that also look like it in crappy locales with equally questionable friend pool

You basically just become like the rest of America, broke, poor, unremarkable, and a target demographic for presidential campaign callers. I lived this life…it’s painfully boring. You literally go nowhere.

Honestly medicine is interesting but not so interesting that the loss of that income would make me stay. I would just stop caring.

Don't forget the diabetes, HTN, kidney disease, obesity and all the other "lifestyle" diseases doctors blame their patients for. Those come along with what you describe.

 

[The kitchen sink]

There is nothing to fight about. The war was lost long Ago. We gave them our plunder for the hope they would continue to allow us to work their fields. Now the ages for working their fields is about to collapse. Little to nothing left to do. What are we defending ? our ****ty position in the house of medicine? Proving to number crunchers we are “better” than Jenny mcjennyson and her online medical degree? No one cares one iota. We are trying to fight a fight we find interesting not the one our owners think matters. It’s a lost cause. I’m sad to say so but it’s game over. It’s now a matter of how terrible it will be. Will the hourly rate drop to 160 or 140. Im not getting all hot and bothered by that. We sad idly on our hands while taking L after L On issues that impacted our pay much more. It’s game over now kids. Find a plan b. Let the idiots who don’t listen suffer. Be better than the idiots. Most wont be.

Just for funzies/hypothetically: what if every medical school got together and somehow, someway make every med school award an MD/DO + JD or MBA or MHA mandatory and created a targeted campaign to retake medicine.

 

[EctopicFetus]

Just for funzies/hypothetically: what if every medical school got together and somehow, someway make every med school award an MD/DO + JD or MBA or MHA mandatory and created a targeted campaign to retake medicine.

Would be great. Issue is it won’t happen. No one wants more educational debt, the schools themselves are a major part of the problem. Docs only want to be the CEO of the hospital. Few want to do the menial and lower paying work of cmo, sitting on committees etc. We are doomed.

I’m part of it. I debated getting an mba. The cost benefit made no sense. My family would suffer and frankly I still like clinical medicine.

 

[The kitchen sink]

Would be great. Issue is it won’t happen. No one wants more educational debt, the schools themselves are a major part of the problem. Docs only want to be the CEO of the hospital. Few want to do the menial and lower paying work of cmo, sitting on committees etc. We are doomed.

I’m part of it. I debated getting an mba. The cost benefit made no sense. My family would suffer and frankly I still like clinical medicine.

Just goes to show, capitalism and corporations are the strongest force in the states. Medical schools are as guilty as the rest of us. I believe NYU has waived tuition for their students, is there any that model can be recreated to reduce debt burden and moral injury? Then maybe the hypothetical could move info the realm of feasibility.

 

[EctopicFetus]

Just goes to show, capitalism and corporations are the strongest force in the states. Medical schools are as guilty as the rest of us. I believe NYU has waived tuition for their students, is there any that model can be recreated to reduce debt burden and moral injury? Then maybe the hypothetical could move info the realm of feasibility.

NYU waived it for primary care only I believe. Better to be an ent with 400k in debt than a pcp with no debt. My 2 cents.

 

[bronx43]

NYU waived it for primary care only I believe. Better to be an ent with 400k in debt than a pcp with no debt. My 2 cents.

It's for all students. They are hoping that it will lead to more people going into primary care, but like you said... no chance that happens.

With that said, primary care isn't actually a terrible gig these days. Outside of a few top earning specialties, it's actually competitive in terms of pay and geographic flexibility.

 

[deleted941485]

It's for all students. They are hoping that it will lead to more people going into primary care, but like you said... no chance that happens.

With that said, primary care isn't actually a terrible gig these days. Outside of a few top earning specialties, it's actually competitive in terms of pay and geographic flexibility.

just means your ROI is that much better for lucrative specialties

 

[EctopicFetus]

It's for all students. They are hoping that it will lead to more people going into primary care, but like you said... no chance that happens.

With that said, primary care isn't actually a terrible gig these days. Outside of a few top earning specialties, it's actually competitive in terms of pay and geographic flexibility.

I did double check and you are right with regards to nyu. Regarding medical specialties check again. Primary care is fairly terrible. Many docs can earn 2x what they make. Hospitalists rarely make $180/hr. That’s the less than the norm for em. The salary surveys have a 100k plus delta from primary care and in reality it’s way more than 100k.

 

[EctopicFetus]

It's for all students. They are hoping that it will lead to more people going into primary care, but like you said... no chance that happens.

With that said, primary care isn't actually a terrible gig these days. Outside of a few top earning specialties, it's actually competitive in terms of pay and geographic flexibility.

Meds ape has pcps vs specialists at a 100k delta. Their numbers are off avg em pay is about 380k a year. Anesthesia in the 400+ range. Primary care is fairly unpopular and they often don’t get the best students. It’s sad but true.

 

[VA Hopeful Dr]

Meds ape has pcps vs specialists at a 100k delta. Their numbers are off avg em pay is about 380k a year. Anesthesia in the 400+ range. Primary care is fairly unpopular and they often don’t get the best students. It’s sad but true.

If you're looking at income alone, primary care doesn't look as good as many specialties. Although I think the medscape numbers are a little low. Doximity recently published their salary data and it looks more like what I'm seeing.

But you also have to factor in other aspects of the work. Like the no nights/weekends/holidays. Control over our schedules. No one dies in my office. You get the idea.

I'm quite happy to take less money in exchange for that, especially as many of us still do quite well.

 

[WilcoWorld]

If you're looking at income alone, primary care doesn't look as good as many specialties. Although I think the medscape numbers are a little low. Doximity recently published their salary data and it looks more like what I'm seeing.

But you also have to factor in other aspects of the work. Like the no nights/weekends/holidays. Control over our schedules. No one dies in my office. You get the idea.

I'm quite happy to take less money in exchange for that, especially as many of us still do quite well.

Wait, you mean money isn't the only determinant of happiness? I think you're in the wrong forum

 

[VA Hopeful Dr]

Wait, you mean money isn't the only determinant of happiness? I think you're in the wrong forum

What I've noticed is that the fields where this is the most talked about also seem to be the ones that people are the most unhappy with their work. I don't mean this as a slight against EM (or anesthesia as they are the other one I see in this area) but more a reflection of the work itself. As y'all say all the time, EM isn't a field that most people can do into their 60s and keep their mental health intact. With that in mind, its absolutely worth putting lots of emphasis on money so you don't have to keep working full time if you burn out.

That and I do like to push back against the idea that primary care doesn't make any money. I don't make ortho money, but most of us make a good bit more than people think.

 

[WilcoWorld]

What I've noticed is that the fields where this is the most talked about also seem to be the ones that people are the most unhappy with their work. I don't mean this as a slight against EM (or anesthesia as they are the other one I see in this area) but more a reflection of the work itself. As y'all say all the time, EM isn't a field that most people can do into their 60s and keep their mental health intact. With that in mind, its absolutely worth putting lots of emphasis on money so you don't have to keep working full time if you burn out.

That and I do like to push back against the idea that primary care doesn't make any money. I don't make ortho money, but most of us make a good bit more than people think.

I'm not so naïve as to claim that money doesn't matter at all, but I do think that this EM forum tends to overstate it's importance. I make significantly less than a lot of the numbers I see quoted here, and I think I have a wonderful quality of life. I wonder if many of us have gotten stuck in jobs we don't like, because we've been fooled into thinking we need exceedingly high salaries. There are a lot of components of my job satisfaction, and once my monetary needs have been met, getting paid more doesn't really make me more satisfied.

I acknowledge that I appear to be in the minority on this.

 

[Arcan57]

I'm not so naïve as to claim that money doesn't matter at all, but I do think that this EM forum tends to overstate it's importance. I make significantly less than a lot of the numbers I see quoted here, and I think I have a wonderful quality of life. I wonder if many of us have gotten stuck in jobs we don't like, because we've been fooled into thinking we need exceedingly high salaries. There are a lot of components of my job satisfaction, and once my monetary needs have been met, getting paid more doesn't really make me more satisfied.

I acknowledge that I appear to be in the minority on this.

The pool of "good" EM jobs feels like it's shrinking. There have always been docs chasing the $$$s and they inevitably cycle through a string of increasingly ridiculous working conditions to make that extra $25/hr. What feels new is that a lot of jobs that used to be tough but fair are now just tough. Our specialty is increasingly beholden to the rules of capitalism, which means that as soon as growth starts slowing down then it's time to start slashing expenses to try and get back on the curve. My prior job is an excellent example of that transition. 5 years ago it was an independent group with the doc that owned the contract running the group. Pay was good but not great, main hospital had super complex patients but tons of support. The occasional FSED shift was a nice break from the acuity. Now they're owned by a CMG. Pay at the main hospital is still the same, but now there's no APPs most days, docs have to pay for their scribes. 40-50% of the shifts are now at FSEDs where the volume has ballooned but the pay is the same. They've run through a succession of schedulers with predictably horrible results in terms of circadian rhythm and being able to schedule a life outside of work. I doubt this is an isolated phenomenon.

 

[bravotwozero]

The pool of "good" EM jobs feels like it's shrinking. There have always been docs chasing the $$$s and they inevitably cycle through a string of increasingly ridiculous working conditions to make that extra $25/hr. What feels new is that a lot of jobs that used to be tough but fair are now just tough. Our specialty is increasingly beholden to the rules of capitalism, which means that as soon as growth starts slowing down then it's time to start slashing expenses to try and get back on the curve. My prior job is an excellent example of that transition. 5 years ago it was an independent group with the doc that owned the contract running the group. Pay was good but not great, main hospital had super complex patients but tons of support. The occasional FSED shift was a nice break from the acuity. Now they're owned by a CMG. Pay at the main hospital is still the same, but now there's no APPs most days, docs have to pay for their scribes. 40-50% of the shifts are now at FSEDs where the volume has ballooned but the pay is the same. They've run through a succession of schedulers with predictably horrible results in terms of circadian rhythm and being able to schedule a life outside of work. I doubt this is an isolated phenomenon.

As someone who’s now only PRN with that former group of yours, would concur with most everything you’ve said except for a few things:

The CMG went back to paying for the scribes.

As for midlevel coverage, it’s not that they got rid of the midlevels, they can’t seem to recruit enough to cover their shifts. Other CMGs in the area, including the one I’m full time at, also have the same problem.

The FSEDs are seeing a massive jump in volume for sure, but that also has translated to more money via RVU payments for docs. APP even paid out retroactive RVU payments that they were holding out on for about 3 months.Nobody is just making base pay at those FSEDs there, we’re averaging about $210/hr with RVUs. I’d still argue that’s on the low end given the volume, but that’s me.

Even the x-mas bonus came back this year for the full timers!

Not trying to defend APP here, but just wanted to get some facts straight.

 

[alpinism]

I'm not so naïve as to claim that money doesn't matter at all, but I do think that this EM forum tends to overstate it's importance. I make significantly less than a lot of the numbers I see quoted here, and I think I have a wonderful quality of life. I wonder if many of us have gotten stuck in jobs we don't like, because we've been fooled into thinking we need exceedingly high salaries. There are a lot of components of my job satisfaction, and once my monetary needs have been met, getting paid more doesn't really make me more satisfied.

I acknowledge that I appear to be in the minority on this.

Sad to say but the specialty has always been a popular choice for docs that value money above everything in life which helps explain the rise in corporate groups.

 

[namethatsmell]

If you're looking at income alone, primary care doesn't look as good as many specialties. Although I think the medscape numbers are a little low. Doximity recently published their salary data and it looks more like what I'm seeing.

But you also have to factor in other aspects of the work. Like the no nights/weekends/holidays. Control over our schedules. No one dies in my office. You get the idea.

I'm quite happy to take less money in exchange for that, especially as many of us still do quite well.

Wait, you mean money isn't the only determinant of happiness? I think you're in the wrong forum

What I've noticed is that the fields where this is the most talked about also seem to be the ones that people are the most unhappy with their work. I don't mean this as a slight against EM (or anesthesia as they are the other one I see in this area) but more a reflection of the work itself. As y'all say all the time, EM isn't a field that most people can do into their 60s and keep their mental health intact. With that in mind, its absolutely worth putting lots of emphasis on money so you don't have to keep working full time if you burn out.

That and I do like to push back against the idea that primary care doesn't make any money. I don't make ortho money, but most of us make a good bit more than people think.

I'm not so naïve as to claim that money doesn't matter at all, but I do think that this EM forum tends to overstate it's importance. I make significantly less than a lot of the numbers I see quoted here, and I think I have a wonderful quality of life. I wonder if many of us have gotten stuck in jobs we don't like, because we've been fooled into thinking we need exceedingly high salaries. There are a lot of components of my job satisfaction, and once my monetary needs have been met, getting paid more doesn't really make me more satisfied.

I acknowledge that I appear to be in the minority on this.

Unless I'm missing something, methinks you guys actually agree...

And I agree with you. Money isn't everything. My main gig pays less than several other options I've had, but it's exactly what I need. Generally low stress and mostly grateful patients. No clipboard nurses. Zero bs metrics to deal with. No pph or production goals. Reasonable workload with enough time to give good care to complex patients. Solid resources. Patient volumes rising? Group's answer isn't to flog folks into seeing more patients...it's to hire more docs. Bankers hours only and no nights/weekends/holidays. Tons of paid time off and actual work-life balance. To me, all of these things are much more valuable than nabbing every last dollar.

I still make decent coin but have almost none of the moral-injury type issues that have arisen at many prior jobs.

Simply chasing $$$ in medicine is a recipe for disaster.

 

[EctopicFetus]

As someone who’s now only PRN with that former group of yours, would concur with most everything you’ve said except for a few things:

The CMG went back to paying for the scribes.

As for midlevel coverage, it’s not that they got rid of the midlevels, they can’t seem to recruit enough to cover their shifts. Other CMGs in the area, including the one I’m full time at, also have the same problem.

The FSEDs are seeing a massive jump in volume for sure, but that also has translated to more money via RVU payments for docs. APP even paid out retroactive RVU payments that they were holding out on for about 3 months.Nobody is just making base pay at those FSEDs there, we’re averaging about $210/hr with RVUs. I’d still argue that’s on the low end given the volume, but that’s me.

Even the x-mas bonus came back this year for the full timers!

Not trying to defend APP here, but just wanted to get some facts straight.

Google “American physician partners debt Bloomberg”.

 

[EctopicFetus]

If you're looking at income alone, primary care doesn't look as good as many specialties. Although I think the medscape numbers are a little low. Doximity recently published their salary data and it looks more like what I'm seeing.

But you also have to factor in other aspects of the work. Like the no nights/weekends/holidays. Control over our schedules. No one dies in my office. You get the idea.

I'm quite happy to take less money in exchange for that, especially as many of us still do quite well.

My response will be brief and hopefully I can add more tomorrow. I think it’s a bit of an oversimplification. I truly enjoy what I do. I work on average under 100 clinical hours a month. I’ve been in the 1100-1150 range for about the past 5 years. Yes nights (not many) yes weekends (my share) but I’m not there that much and I enjoy my co workers, the work itself and the pay. If my pay dumped I would work even less.

Em docs almost by rule and anesthesia have a ton of non clinical interests and the time to explore those interests.

While we may talk a lot about money I believe I saw pcps work about 55 hours a week for that money. Curious your take on that.

 

[nimbus]

Just goes to show, capitalism and corporations are the strongest force in the states. Medical schools are as guilty as the rest of us. I believe NYU has waived tuition for their students, is there any that model can be recreated to reduce debt burden and moral injury? Then maybe the hypothetical could move info the realm of feasibility.

New Kaiser med school in Southern CA is also tuition free.

New Medical School Will Waive Tuition for First Five Classes | Kaiser Permanente Bernard J. Tyson School of Medicine

medschool.kp.org

 

[nimbus]

NYU waived it for primary care only I believe. Better to be an ent with 400k in debt than a pcp with no debt. My 2 cents.

No, it’s tuition free for everyone. Prospective students can also prematch into postgrad specialty training at NYU and be done with med school in 3years to save even more money on fees and living expenses. Hopefully all medical schools, or all top tier schools with adequate funding, will go this route.

Affordability & Financial Aid for MD Students | NYU Langone Health

NYU Grossman School of Medicine Office of Financial Aid helps students find resources to cover medical school expenses beyond tuition.

med.nyu.edu

Direct Progression to an NYU Grossman School of Medicine Residency | NYU Langone Health

At NYU Grossman School of Medicine, our three-year MD degree program offers conditional acceptance to a residency in one of 20 specialties.

med.nyu.edu