Why are salary estimations so terrible?

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TRPMinus

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I am from the Midwest, and am looking towards EM as my choice of specialty. Realistically, I was expecting to make somewhere between 200 K – 300 K per year. Last week I was talking to an ER physician in my area and he mentioned that EM has some pretty obvious financial benefits. I asked him what he meant by this, and he told me that in our area it was fairly easy to find a salary in the 500 K region. I feel like every website like salary.com etc. underestimates how much money physicians make.......why?
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Websites like that are not likely the best resources for salary info.

There are wide ranges and outliers for every specialty. Go to an academic center in a very desirable city and you will be at the low range. Go to very rural areas that many don't want to live and resources are likely quite sparse and you will likely do quite well for yourself. Then there's everywhere in between.
 
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TRPMinus said:
I am from the Midwest, and am looking towards EM as my choice of specialty. Realistically, I was expecting to make somewhere between 200 K – 300 K per year. Last week I was talking to an ER physician in my area and he mentioned that EM has some pretty obvious financial benefits. I asked him what he meant by this, and he told me that in our area it was fairly easy to find a salary in the 500 K region. I feel like every website like salary.com etc. underestimates how much money physicians make.......why?
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Too tired to write prose, so bullets.

#1 Healthcare economics are complicated. Physician compensation is a tiny piece of the big puzzle, but it is often not as straight forward as, "physician signs contract for salary and gets said salary payable every 2 weeks like many other jobs are."
#2 Learn a little bit about how physicians are paid. Understand the basic practice models and things will become clearer as to why the numbers are always fuzzy.
#3 Realize that many physicians don't have salaries. Their income is derived by essentially running a small business or are a part of a small/medium/large business. Thus, their compensation may be very high (or very low), they may not actually have a contractual salary worth mentioning.
#4 Salary estimates are self reported, except for a minority of positions (eg. some (all?) states publish how much every one of their employees makes). There are many reasons that private groups do not publish their financial details including how much their physicians are making.
#5 The best way of getting a decent ballpark idea of salaries that different specialties offer is to talk to recent residency graduates about the offers that they got for their first jobs. They are the most reliable because they are a) current and b) generally homogeneous because the physician they are hiring is fresh out of training. For example, in vascular surgery, our most recent graduates reported salaries ~350k for academic jobs and ~450k in the private realm with an expectation that the new hire's compensation be based largely on how much business they bring in after 2-3 years.
 
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I wonder if hospitals pay an industry standard or if there are extensive negotiations. If the latter, I could imagine many physicians graduating who have never had to negotiate for a salary before in their life and so you would expect some to be good at it and some not so good. Urban vs. rural location probably also plays into it.
 
kamakazi5 said:
Websites like that are not likely the best resources for salary info.

There are wide ranges and outliers for every specialty. Go to an academic center in a very desirable city and you will be at the low range. Go to very rural areas that many don't want to live and resources are likely quite sparse and you will likely do quite well for yourself. Then there's everywhere in between.
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I've never understood the argument that salaries are much greater in rural underserved areas. Perhaps we just have a spectacularly terrible hospital here (a distinct possibility), but the physicians in this area (which is most definitely rural and most definitely underserved) get paid significantly less than the surrounding large cities. The local hospital has been trying to hire another full-time ER physician for several years with no luck - mostly because they're capping the offered salary at less than $125k.
 
aldol16 said:
I wonder if hospitals pay an industry standard or if there are extensive negotiations. If the latter, I could imagine many physicians graduating who have never had to negotiate for a salary before in their life and so you would expect some to be good at it and some not so good. Urban vs. rural location probably also plays into it.
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Remember that many physicians are not employed by hospitals and are instead hired by private groups. There isn't really an "industry standard" that fits an entire specialty because of how different practices are setup. For fresh graduates, there is some negotiation, but largely not on salary. Most groups know the volume that they are looking for the new partner to pick up, the overhead costs etc. The number they offer typically is 'tied' to a certain percentage of the MGMA, but is more of a calculation of what the new partner brings to the table. Virtually every talk about landing your first attending job discusses contract negotiation and every single one of them says the same thing, "Don't focus on the salary, it is the least important part of the contract." It is everything else that you should be worried about. ie. What the expectations are, how the practice will help you grow. How much mentorship from senior partners you can expect, what the anticipated volume/referral patterns are, office staff support, hospital support, mid-level support, etc.

blackroses said:
I've never understood the argument that salaries are much greater in rural underserved areas. Perhaps we just have a spectacularly terrible hospital here (a distinct possibility), but the physicians in this area (which is most definitely rural and most definitely underserved) get paid significantly less than the surrounding large cities. The local hospital has been trying to hire another full-time ER physician for several years with no luck - mostly because they're capping the offered salary at less than $125k.
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There is something else at play here in your example, or the hospital is as you say, terrible. Demand drives up salaries. There are simply put, far more residency graduates looking to stay in large cities than there are those willing to go to rural areas. Thus, to attract talent, rural market hospitals/groups have to offer more to attract physicians. Remember the numbers I posted above? There are also several vascular surgery jobs offering well publicized 600k+ for a FRESH GRADUATE in several rural areas.
 
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EM pay is described in the EM forum. but going rate is between $140 and $350/hr. depends on how much you work -- you can hit north of 500k. but youll be working quite hard for that.

northeast,cali and large cities pay the least.

I dont work too much but make in the mid 300s. im happy with that. each additional hour is taxed a marginal rate of 43% including state taxes.

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@mimelim OK. Number four makes a lot of sense. Many of the emergency medicine doctors in my area are part of a private group. That has to be why salaries are reported so much less. Thanks for the response!!
 
Huggy said:
Is it common for fresh graduates to take a job opportunity in a rural area, live frugally for a few years, pay off all debt, accumulate wealth rapidly, and then move to a more desirable location? Not interested in the ethics of this scenario.
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What ethics would there even be to "not be interested in" given that scenario?

It's done all the time and is perfectly normal.
 
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Huggy said:
Is it common for fresh graduates to take a job opportunity in a rural area, live frugally for a few years, pay off all debt, accumulate wealth rapidly, and then move to a more desirable location? Not interested in the ethics of this scenario.
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I dont think its all that common tbh. I know plenty of people who declined offers that were 200k+ more in podunk no where. Past a certain point money doesnt really do all that much for people and besides what is there to buy in rural montana?
 
Wow, 500k for EM would be pretty insane.
Once you matriculate at a medical school you'll get access to AAMC's Careers in Medicine website, which has salary info on it that I'm assuming is fairly accurate.
 
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AnatomyGrey12 said:
Land my good sir, lots of land.
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yeah but if you're a person who grew up in the city the idea of owning large plots of land is very random and you probably wont get a kick out of it except for maybe speculation but investing in something you dont know is a horrible idea
 
RogueUnicorn said:
so in EM that'll be... like half as hard as a surgeon?
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Ooohhh snap. Say that again after you've been through the whole deal. You'd find it very offensive.


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shoal007 said:
Ooohhh snap. Say that again after you've been through the whole deal. You'd find it very offensive.


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Must have been super hard for you dealing with working a big time 60 hours/week for 3 whole years ;-)
 
Lannister said:
Wow, 500k for EM would be pretty insane.
Once you matriculate at a medical school you'll get access to AAMC's Careers in Medicine website, which has salary info on it that I'm assuming is fairly accurate.
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The ER docs I scribe for in the rural Midwest make 500K. It's not really that rural either. I work in a city of 400,000.
 
Whenever
Winged Scapula said:
Who are all these people that discuss their income with co-workers?
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Whenever I told the docs I work with I was accepted they started to become a lot more open with me about their salary, debt, etc. One locum straight up said one day "Hey, you know how much they're paying me to be here? $500/hr!!" totally unprovoked.
 
If bullying nia avigmpeovlem in. Edical cultufre I would bet vullahitting is as well. Can't wait to find out.
 
gallons said:
If bullying nia avigmpeovlem in. Edical cultufre I would bet vullahitting is as well. Can't wait to find out.
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raw
 
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gallons said:
If bullying nia avigmpeovlem in. Edical cultufre I would bet vullahitting is as well. Can't wait to find out.
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Can't wait to find out either
 
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CCmetal94 said:
Whenever

Whenever I told the docs I work with I was accepted they started to become a lot more open with me about their salary, debt, etc. One locum straight up said one day "Hey, you know how much they're paying me to be here? $500/hr!!" totally unprovoked.
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I remain unconvinced (at least that those are truthful rates).

If you talk to SDN EM physicians, what they quote as rates for that specialty are not $500K per year. And while $500 per hour might not be unreasonable for a locums position, remember these are not full time/permanent jobs .

My sense is that when asked in a public forum with relative strangers people lie about salary: either too high or too low. Heck, that's the whole point of this thread: even salary surveys are inaccurate largely because people either over or underestimate salaries, IMHO.
 
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gallons said:
If bullying nia avigmpeovlem in. Edical cultufre I would bet vullahitting is as well. Can't wait to find out.
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Haha apple devices I guess are not as good as android at voice to text. I was saying something about how bullying and bull ****ting go hand in hand. But "vullahitting" sounds really cool so I think I will leave that post as is.:D
 
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gallons said:
If bullying nia avigmpeovlem in. Edical cultufre I would bet vullahitting is as well. Can't wait to find out.
Click to expand...

dont drink and SDN
 
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