will EM salaries drop alot

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ronaldo23

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in 20-30 years, or even soon with hilary care?
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As things get worse, Hillary, older population, more addiction and liability and so on we'll keep taking hits. I expect 5-10% in the next 5 years then worse. If we just get socialized then we're just looking into a bottomless pit.
 
I dont think we will be going socialized personally- although everyone on here seems to think so.
 
^ and I think Obama will lose.
 
At what salary would you guys not be willing to go into emergency medicine?

Asked another way - fill in the blank: If, during my second year of medical school, I discovered that the average salary for an EM attending would be _____________ when I graduated from residency, I would choose
another specialty.
 
200k. Then again, that is in today's dollars. A more interesting question would be what salary cut attendings would be willing to tolerate, while they continue to pay their mortgages and student loans. I'm an optimist, but I also believe that we are currently practicing socialized medicine and don't stand to lose too much. We may even come out ahead.
 
Really, today about 50% of patients are covered by some sort of Federally sponsored insurance program, whether it be Medicare, Medicaid, Tricare, or the VA. Then, most insurance companies base their reimbursement of some percentage of Medicare. So, we really do have a 2 tier system. If you have money and good insurance, you generally get to see better docs at better hospitals.

Regarding the pay, I think locum tenens provides a good way to hedge against poor reimbursement. When I started practice way back in 2001, one of my former partners told me to always have more than one medical license and stay credentialed with a locums company. That way, if you start to get jerked around, you can go do locums. There was a situation in Arizona, where a group of anesthesiologists and CRNAs were getting screwed by their hospital, which had picked up a bunch of contracts which paid the anesthesia group next to nothing. They tried to negotiate with the hospital, which blew them off. They all quit and signed up with a locums company and the hospital had to contract with the agency to get them back to cover the cases at a much higher cost. They subsequently worked out a good contract.

I think $200 grand is a minimum salary for EM. Personally, I would have needed $400 grand to do it. EM is a difficult, stressful specialty. Smart people these days have numerous options and doing EM for $100,000/yr just doesn't add up when they can make more money being an accountant, pharmacist, IT professional, or many other jobs. My brother is an IT guy with a BS degree in computer science making $150-$200 an hour and he gets to sleep in his bed every night.

Most countries with socialized medicine have a public sector and a private sector. The scabs will work for the public sector, just like California is trying to bring in non-US trained physicians (mostly from Mexico) to take care of Medi-Cal patients and the good people will work in the private sector. It is not necessarily how it should be, but it is reality.
 
My biggest fear is not being able to pay off the loans I have racked up through med school. I want to be able to pay them off in 5-10 years, and with the way things are looking, this may be near impossible. Hopefully there are powerful people out there pulling for us who are in this situation.
 
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Okay, I'm not very financially savvy, and even less politically savvy - but I'm a little confused about how having a more socialized healthcare system would affect EM?

Now, this may extend to my lack of knowledge about EM billing, but dont emergency physicians get paid even if the does not have insurance? I'd think as time progresses and we have increased addiction, an aging population, and more widespread insurance coverage, the emergency physicians job would be more important - you'd have more serious injuries with the older people, and then a larger portion of the patients would be seriously ill as opposed to primary care only.

Wouldnt that at least serve to keep EM salaries the same?
 
Roy7 said:
Okay, I'm not very financially savvy, and even less politically savvy - but I'm a little confused about how having a more socialized healthcare system would affect EM?

Now, this may extend to my lack of knowledge about EM billing, but dont emergency physicians get paid even if the does not have insurance? I'd think as time progresses and we have increased addiction, an aging population, and more widespread insurance coverage, the emergency physicians job would be more important - you'd have more serious injuries with the older people, and then a larger portion of the patients would be seriously ill as opposed to primary care only.

Wouldnt that at least serve to keep EM salaries the same?
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The assumption (it's valid but it is an assumption) is that any system that introduces more socialism or universal coverage or egalitarianism or whatever will be trying to do more with less. One of the easiest ways to strech the dollars it to pay people including doctors including EPs less. However you slice it it will be a loss for us. If anyone was found to be doing as well or better than the pre socialist market then the system would knock them down to get at that savings.
 
i actually think the em salary will go up (at first) when we socialize. notice i didn't say if, because no matter what anyone says, this wagon's broke. even if obama gets elected, we're probably looking at more change than there has been in the last 8 years. in the ed, we see everyone (thanks emtala), regardless of whether we get paid. we get reimbursed for 30% of the work we do, when the bill gets paid by insurers. if we were socialized, we would get paid for everyone that walks through the door. that money of course doesn't go directly to us, but to the hospital. better compensation from the ed for the hospital will trickle down to ep's. the big pay cut is going to hit surgeons, ophthos, and derms, that won't be able to say no to freeloaders.
 
This would be interesting - would acuity go up in these scenarios since patients would presumably have access to better primary care, and hence all the med refills would no longer be packing the ED waiting area? If acuity went up, would the percentage of patients billed at a higher rate actually increase, thus while volume would go down, incomes would increase?
 
dr. blue said:
that money of course doesn't go directly to us, but to the hospital. better compensation from the ed for the hospital will trickle down to ep's. the big pay cut is going to hit surgeons, ophthos, and derms, that won't be able to say no to freeloaders.
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Are you talking about now or after the start of the reign of darkness? If you're talking about now few of us get paid by the hospitals. Most EPs make their money by billing patients. If some bit goes through that were to increase hospital reimbursement (unlikley, they'll probably take it in the shorts just like us) the majority of us won't get a slice of that pie.
 
I'm going to take the opposite argument and say that out of all specialities, EM salaries are probably the most likely to continue steadily rising despite factors that will push most other physician salaries down. The reason is because as far as I can tell, hospital-based specialities or specialties that get a lot of their income from hospitals (gas, em, rads, cards using that community hospital cath-lab) and many mid-to-large sized community hospital (that employ the most EM physicians) have weathered the reimbursement cuts of the past 15 years fairly well. Take a look around America, and hospitals are often the largest employer in town. I'm not naive enough to think that politicians care about the community health benefits of local hospitals, but it's bad politics when hospitals loose money and close. So despite cuts for physician reimbursements, the government will continue to make sure hospitals do ok. And the ER is the face and cash cow of the community hospital, generating those lucrative imaging studies and inpatient admissions. And ER's need EM physicians. When little Johnny breaks his arm or Uncle Joe gets pain shooting down his arm, they want to see a physician. ER visits keep steadily increasing in this country, and that'll continue to happen even with universal healthcare I reckon. EM physician demand will continue to be strong, and despite cuts in individual procedure reimbursements EM physicians will continue to be able to demand high salaries from hospitals, because hospitals have the money and need EM docs. Salaries will continue to increase, and fee-based groups will demand and get retainers to keep the ER staffed.

It's already happening. Ask almost any EM doc and they'll tell you their compensation has steadily increased over the last 10 years. While (almost) everyone else has taken a hit. The future of EM is bright.
 
old_boy said:
I'm going to take the opposite argument and say that out of all specialities, EM salaries are probably the most likely to continue steadily rising despite factors that will push most other physician salaries down. The reason is because as far as I can tell, hospital-based specialities or specialties that get a lot of their income from hospitals (gas, em, rads, cards using that community hospital cath-lab) and many mid-to-large sized community hospital (that employ the most EM physicians) have weathered the reimbursement cuts of the past 15 years fairly well. Take a look around America, and hospitals are often the largest employer in town. I'm not naive enough to think that politicians care about the community health benefits of local hospitals, but it's bad politics when hospitals loose money and close. So despite cuts for physician reimbursements, the government will continue to make sure hospitals do ok. And the ER is the face and cash cow of the community hospital, generating those lucrative imaging studies and inpatient admissions. And ER's need EM physicians. When little Johnny breaks his arm or Uncle Joe gets pain shooting down his arm, they want to see a physician. ER visits keep steadily increasing in this country, and that'll continue to happen even with universal healthcare I reckon. EM physician demand will continue to be strong, and despite cuts in individual procedure reimbursements EM physicians will continue to be able to demand high salaries from hospitals, because hospitals have the money and need EM docs. Salaries will continue to increase, and fee-based groups will demand and get retainers to keep the ER staffed.

It's already happening. Ask almost any EM doc and they'll tell you their compensation has steadily increased over the last 10 years. While (almost) everyone else has taken a hit. The future of EM is bright.
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Guys, seriously, you don't know what you're talking about. The vast majority of EPs are NOT hospital employees. We are contractors. We don't get paid by the hospitals. We get paid by the patients we bill for our services. CMS can cut our reimbursement and it will not have any effect at all on the hospitals. You guys have got to understand this before you start looking for jobs let alone before you start throwing out opinions about medical economics without even being able to follow the money.

As for the people who "want to see a doctor" that's fine and that's why we've been as sheltered as we have been. We managed to get the "prudent layperson" and so on (again if you don't know the politics of that fight or what that even is you better do some research) but those concessions won't last forever. HMO patients want to see doctors too. They see midleves. They want to go to specialists unreferred. They can't. If you think that policies under a universal system will be more lenient than under an HMO you're really kidding yourself.
 
docB said:
If you think that policies under a universal system will be more lenient than under an HMO you're really kidding yourself.
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ACP endorsed single payer universal health care on Thursday. The PNHP group has demonstrated, along with many other health care economist, that the finances of single payer medicine make sense. It improves access to services, patient care, saves us all money, and decreases the % GDP we spend on medicine in the U.S.

3 JAMA articles in the past decade have shown that salaries for most fields would not decrease under such model (but might decrease in fields like neurosurg or ortho).

Everyone saves money in single payer by decreasing admin costs, taking away the profit model for HMOs and increasing quality/ending med mal. We also save money by bargaining for drug costs -- like the V.A. -- as a large group in the single payer model.

67% of our health care is "socialized" already -- medicare, medicaid, VA, federal health care (congress/senate/other govt workers), teachers -- expanding that allows us to bill - and get reimbursed-- for every pt seen.

The bottom line is that this is no longer an economic argument - it is a moral one. The data is there to show the economics make more sense. So go read it. Unfortunately, our medical schools and training programs do us a huge disservice -- they put us in the trenches of health care without any formal understanding of health care economics/policy.

It is a matter of demonstrating that health care is a right that we deserve access to in this country and that the business models of private insurance can, by definition, not provide that right to everybody (b/c that wouldn't maximize profits). And, like global warming, it is an issue of convincing people of observable common sense in the light of powerful lobbies of private insurance.

Physicians for a National Health Program http://www.pnhp.org
ACP Position Statement/Paper
HR 676 "Medicare for All"
 
Also, I think this argument could be made more prudent if we focused on realistic goals in our field. Namely, working on reimbursement problems under the model we currently face - as opposed to a theoretical model that hasn't come to pass and isn't even close to arriving since the most liberal proposals at hand are for expanding insurance coverage, not health coverage.

My point is that the major problem facing us is not the "threat" of "socialized" medicine but is, instead, the real possibility of CMS cuts to funding and the lack of funding in EMTALA.

In other words, focus your energy on passing the "Access to Emergency Medicine Services Act". That would take away the threat of the very real cuts that have built up in the CMS funding model.

Plus, by linking to EMTALA to federal funding, and adding sovereign immunity for health care providers covering EMTALA pts, we would go a long way in solving the more real problems of the on-call specialist shortage.

Support S 1003/HR 882
 
zinjanthropus said:
ACP endorsed single payer universal health care on Thursday. The PNHP group has demonstrated, along with many other health care economist, that the finances of single payer medicine make sense. It improves access to services, patient care, saves us all money, and decreases the % GDP we spend on medicine in the U.S.

3 JAMA articles in the past decade have shown that salaries for most fields would not decrease under such model (but might decrease in fields like neurosurg or ortho).

Everyone saves money in single payer by decreasing admin costs, taking away the profit model for HMOs and increasing quality/ending med mal. We also save money by bargaining for drug costs -- like the V.A. -- as a large group in the single payer model.

67% of our health care is "socialized" already -- medicare, medicaid, VA, federal health care (congress/senate/other govt workers), teachers -- expanding that allows us to bill - and get reimbursed-- for every pt seen.

The bottom line is that this is no longer an economic argument - it is a moral one. The data is there to show the economics make more sense. So go read it. Unfortunately, our medical schools and training programs do us a huge disservice -- they put us in the trenches of health care without any formal understanding of health care economics/policy.

It is a matter of demonstrating that health care is a right that we deserve access to in this country and that the business models of private insurance can, by definition, not provide that right to everybody (b/c that wouldn't maximize profits). And, like global warming, it is an issue of convincing people of observable common sense in the light of powerful lobbies of private insurance.

Physicians for a National Health Program http://www.pnhp.org
ACP Position Statement/Paper
HR 676 "Medicare for All"
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Ug. I hate it when the socialized health care debate spills over to the EM board but I just have to point out a few things. Saying that "the data is there, so go read it" a linking to the Physicians for a National Health Program web site is like saying "Pepsi is better than Coke, just go to Pepsi.com and you'll see." As for HR 676 it's sponsored by John Conyers, one of the most deplorable and rabidly liberal congressmen ever.

You quoted my comment that any socialized system was not likely to be less restrictive than an HMO. Then you alluded to the VA twice. We all know that any system would bring together the worst of the VA, medicaid, the IRS, the DMV and so on.

You also shouldn't convince yourself that anyone who does not support socialized care is ignorant. That is the predominant leftist misperception. "If they were all as smart and informed as I am they'd have to agree with me." Many of us are just philosophically opposed to the idea. It embodies the cradle to grave nanny state mentality that we feel is ruining the country. We don't believe that the government can run something like healthcare with any degree of efficiency. We know that we would be negatively affected even if there were isolated positives like single payor billing. Unjustified optimism will not sway us.
 
docB said:
Ug. I hate it when the socialized health care debate spills over to the EM board but I just have to point out a few things. Saying that "the data is there, so go read it" a linking to the Physicians for a National Health Program web site is like saying "Pepsi is better than Coke, just go to Pepsi.com and you'll see." As for HR 676 it's sponsored by John Conyers, one of the most deplorable and rabidly liberal congressmen ever.

You quoted my comment that any socialized system was not likely to be less restrictive than an HMO. Then you alluded to the VA twice. We all know that any system would bring together the worst of the VA, medicaid, the IRS, the DMV and so on.

You also shouldn't convince yourself that anyone who does not support socialized care is ignorant. That is the predominant leftist misperception. "If they were all as smart and informed as I am they'd have to agree with me." Many of us are just philosophically opposed to the idea. It embodies the cradle to grave nanny state mentality that we feel is ruining the country. We don't believe that the government can run something like healthcare with any degree of efficiency. We know that we would be negatively affected even if there were isolated positives like single payor billing. Unjustified optimism will not sway us.
Click to expand...

I'm with you docb. When people from countries with socialized health care come to the US for health care, it's obvious something is still wrong with socialized medicine. When they have to wait 3 months to get a tumor removed, they come and pay for it to be removed in the US so that it gets out of them faster. I myself wouldn't want to wait that long to get something like that removed. I also wouldn't want to wait to see a doctor for 2 weeks when I am sick. And yes, they are doing this quite frequently in some places.

Ok, my rant is off again for a while.
 
WallowaWanderer said:
At what salary would you guys not be willing to go into emergency medicine?

Asked another way - fill in the blank: If, during my second year of medical school, I discovered that the average salary for an EM attending would be _____________ when I graduated from residency, I would choose
another specialty.
Click to expand...

Great question. Then ask yourself which specialty you would have rather pursued. For me personally, there is no I'd rather go into.
 
docB said:
Guys, seriously, you don't know what you're talking about...
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Speaking of which, the OP started a similar thread in Pre-Allo. I liked this quote:

Springhill Mike said:
exactually how i feel i do not want to be rich.. if we had socialized medicine where doctors make 30k a year i would be happy working the same amount.. i am just passionate about being a doctor. most pre-meds see money but dont realize how much doctors work for the higher salary. in retrospect they dont make THAT much when you take in account the hours they work.
Click to expand...
 
zinjanthropous said:
Everyone saves money in single payer by decreasing admin costs, taking away the profit model for HMOs and increasing quality/ending med mal.
Click to expand...

How does moving to a socialized health system end medical malpractice? You won't be giving away your services, so you won't qualify under the Good Samaritan Act. The only thing that will end medical malpractice lawsuits is tort reform. No socialized health system will change that.

And DocB, Pepsi is better than Coke!
 
southerndoc said:
How does moving to a socialized health system end medical malpractice? You won't be giving away your services, so you won't qualify under the Good Samaritan Act. The only thing that will end medical malpractice lawsuits is tort reform. No socialized health system will change that.

And DocB, Pepsi is better than Coke!
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The idea is that, under a single payer system, we would move to a quality improvement model that is seen in other industrialized nations that do not face our exposure-liability crisis. There is a lot of data suggesting that tort reform does not do much for ending the lawsuits and, more importantly, doesn't really save us much money in terms of premiums. More importantly, it doesn't improve patient care.
 
docB said:
You also shouldn't convince yourself that anyone who does not support socialized care is ignorant. That is the predominant leftist misperception. "If they were all as smart and informed as I am they'd have to agree with me." Many of us are just philosophically opposed to the idea. It embodies the cradle to grave nanny state mentality that we feel is ruining the country. We don't believe that the government can run something like healthcare with any degree of efficiency. We know that we would be negatively affected even if there were isolated positives like single payor billing. Unjustified optimism will not sway us.
Click to expand...

That is exactly my point. This is a moral/philosophical argument, not an economic one. I can show the data all day demonstrating the efficiency of single payer, but at the end of the day we disagree on the fundamental idea that health care is a right for all people in this country, regardless of income or employment.
 
EM2BE said:
I'm with you docb. When people from countries with socialized health care come to the US for health care, it's obvious something is still wrong with socialized medicine. When they have to wait 3 months to get a tumor removed, they come and pay for it to be removed in the US so that it gets out of them faster. I myself wouldn't want to wait that long to get something like that removed. I also wouldn't want to wait to see a doctor for 2 weeks when I am sick. And yes, they are doing this quite frequently in some places.

Ok, my rant is off again for a while.
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1. People without health care in this country wait infinitely for needed treatment
2. People with coverage also wait for care in this country when they are denied needed treatments/medicine by HMOs
3. Wait times are shorter in countries with single payer for necessary treatments and emergency care.
4. People from places with single payer don't come here for needed treatment. Although, they may very well arrive for cosmetic or unrequired care.
 
One more thing, I'm not very smart but your leaders in this field and in other parts of medicine that make up the IOM are more experienced and insightful then any of us here. In 2004, IOM wrote a policy paper supporting universal health care in this country.

Let me go one step further and point out that EM's own Arthur Kellerman was an author on that report (co-chair actually). Obviously Kellerman is a leader of our field (ACEP, Emory, IOM, etc). Last month, he spoke at the PNHP conference, continuing his support for single payer.

Why would your leaders want to support policy that hurts their own careers and the future of their own field? Why do your anecdotal experiences trump the collected data/experiences of many others in EM?

IOM Report on the Consequences of Uninsurance - Insuring America's Health 2004
 
zinjanthropus said:
There is a lot of data suggesting that tort reform does not do much for ending the lawsuits and, more importantly, doesn't really save us much money in terms of premiums.
Click to expand...

Just come to Texas and I'll be happy to show you that tort reform works remarkably well.

Insurance premiums have dropped dramatically. The number of lawsuits has dropped. The number of insurance carriers had increased.

Prop 12 worked.

Take care,
Jeff
 
Right now coke is on sale, so it is better than pepsi. But if I find them ever at equal price, it's diet pepsi all the time.
 
zinjanthropus said:
One more thing, I'm not very smart but your leaders in this field and in other parts of medicine that make up the IOM are more experienced and insightful then any of us here. In 2004, IOM wrote a policy paper supporting universal health care in this country.

Let me go one step further and point out that EM's own Arthur Kellerman was an author on that report (co-chair actually). Obviously Kellerman is a leader of our field (ACEP, Emory, IOM, etc). Last month, he spoke at the PNHP conference, continuing his support for single payer.

Why would your leaders want to support policy that hurts their own careers and the future of their own field? Why do your anecdotal experiences trump the collected data/experiences of many others in EM?

IOM Report on the Consequences of Uninsurance - Insuring America's Health 2004
Click to expand...
Academics tend to lean left. These are some of the few EPs who are employed by hospitals and are insulated from issues like payor mix, many have soverign liability an so on. It's not that they want to hurt their field or careers. They assume that once everyone takes their pay cut they'll get used to it. We'll lose some docs and we'll fill the spots with newbies. Everytime there's some change we adapt and we will if we socialize. You are trying to say that I alone disagree with these pillars of whatever. Not true. Many don't want to see socialism in healthcare. And it goes byond a philosophical argument. It's also economic. We believe that the amount of money taken out of the system in profit is less than the waste that will be lost if the government takes it over. We have seen government intervention, regulation and collectivization ruin many industries. Many of us are just left to hope we can complete our careers before the takeover.
 
zinjanthropus said:
1. People without health care in this country wait infinitely for needed treatment
2. People with coverage also wait for care in this country when they are denied needed treatments/medicine by HMOs
3. Wait times are shorter in countries with single payer for necessary treatments and emergency care.
4. People from places with single payer don't come here for needed treatment. Although, they may very well arrive for cosmetic or unrequired care.
Click to expand...

1. No they don't, they go to the ED...remember Bush's new health plan? And, I know if I need an appt, I always get one within a week. Never had a problem with that factor. I just may not go to the preferred doctor, but I will get treated.
2. Can't do much about HMOs, but I've seen the way you can get the treatments after you follow their rules.
3. Don't know about this one.
4. Yes they do...you just haven't seen it yet. Why would they come here just to get even an MRI done? And yes, I've seen it.
 
docB said:
The vast majority of EPs are NOT hospital employees. We are contractors. We don't get paid by the hospitals. We get paid by the patients we bill for our services. CMS can cut our reimbursement and it will not have any effect at all on the hospitals.
Click to expand...

docB-
I addressed this in my post to a certain extent. Admittedly, I am only a med student but I've talked to several EM physicans at my school about this. I think that fee-based EM's will be able to ask for and receive additional money from hospitals if reimbursements begin falling substantially. Demand for boarded EM physicians outstrips supply in most parts of the country. Many community ortho's and anesthesiologists already receive a substantial and growing portion of their income from hospitals as a result of falling reimbursement from the govt/insurer oligopoly.

Hospitals don't NEED primary care docs, and even most specialists, to keep the money coming in. But they need gas-men in the OR, EM docs in the ER, and ortho on call. So they will need to pay extra for these services to fee-based groups who will go elsewhere otherwise.

What do you think will prevent this from happening? What is the breaking point for you in terms of salary when you pick up and look for another employment model (ie, take a salaried position or do locums)? Hospitals know that if reimbursements fall, contractors will pick up and leave, so they won't let this happen.
 
old_boy said:
docB-
I addressed this in my post to a certain extent. Admittedly, I am only a med student but I've talked to several EM physicans at my school about this. I think that fee-based EM's will be able to ask for and receive additional money from hospitals if reimbursements begin falling substantially.
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Why would you think that? The usual situation is that as a payor mix declines the hospital starts losing money and can’t afford to pay anyone, let alone starting to give subsidies to the EPs. Where would this money come from?

old_boy said:
Demand for boarded EM physicians outstrips supply in most parts of the country.
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True but in medicine “demand” and “what people and institutions are willing to pay” are not the same. Most places that don’t staff their EDs with BC EPs would if they could afford it. But they don’t have the payor mix, cash flow, volume to support it so they just don’t. They don’t come up with some extra money from somewhere to give to the EPs.

old_boy said:
Many community ortho's and anesthesiologists already receive a substantial and growing portion of their income from hospitals as a result of falling reimbursement from the govt/insurer oligopoly.
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And many hospitals have just let their call panels dwindle to nothing rather than try to pay these specialists. That’s why there’s a “specialist crisis” in EM. That’s why more and more patients have to be transferred to county/academic centers for definitive care.

old_boy said:
Hospitals don't NEED primary care docs, and even most specialists, to keep the money coming in. But they need gas-men in the OR, EM docs in the ER, and ortho on call. So they will need to pay extra for these services to fee-based groups who will go elsewhere otherwise.
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Given that I work in several hospitals that have just given up ortho rather than pay them I disagree.

old_boy said:
What do you think will prevent this from happening? What is the breaking point for you in terms of salary when you pick up and look for another employment model (ie, take a salaried position or do locums)? Hospitals know that if reimbursements fall, contractors will pick up and leave, so they won't let this happen.
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Yes they will. My group did it 3 years ago. We abandoned a contract because the payor mix declined to the point where we were losing money staffing it. Needless to say the hospital didn’t suddenly come up with extra money. They went to non BC EPs.

I get the impression that your reasoning might be based on the idea that hospitals have extra money available for keeping contract docs around. This is not my experience. Every CEO and COO that I know are on very tight leashes. If revenue drops they have to answer. If the payor mix goes down they get even more stingy.

Here’s a link to a thread about what is more likely to happen when a payor mix starts to decline. It does not feature stories of EPs being given more money by the hospital.
http://forums.studentdoctor.net/showthread.php?t=356024
 
old_boy said:
docB-
I addressed this in my post to a certain extent. Admittedly, I am only a med student but I've talked to several EM physicans at my school about this. I think that fee-based EM's will be able to ask for and receive additional money from hospitals if reimbursements begin falling substantially. Demand for boarded EM physicians outstrips supply in most parts of the country. Many community ortho's and anesthesiologists already receive a substantial and growing portion of their income from hospitals as a result of falling reimbursement from the govt/insurer oligopoly.

Hospitals don't NEED primary care docs, and even most specialists, to keep the money coming in. But they need gas-men in the OR, EM docs in the ER, and ortho on call. So they will need to pay extra for these services to fee-based groups who will go elsewhere otherwise.

What do you think will prevent this from happening? What is the breaking point for you in terms of salary when you pick up and look for another employment model (ie, take a salaried position or do locums)? Hospitals know that if reimbursements fall, contractors will pick up and leave, so they won't let this happen.
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Wrongo my friend. If hospitals really want to make money they need cardiologists in the cath lab, gastroenterologists in the GI lab, and PAs in the fast track.

Given the choice between letting a GI guy who can do 500 scopes a year go or ditching BC EM docs in favor of FPs/internists the hospital would not bat an eye.

Fortunately that is a false dichotomy at this point.

I don't blame the specialists at all. If I had done 7 years of Nsurg I would not want to be waking up in the middle of the night to manage the traumatic brain injuries of the litigious masses for dog**** reimbursement either.
 
docB and AmoryBlaine-

Thank you for your thoughtful critiques of my argument. Although I'm not entirely convinced that what the doomsdayers of SDN predict will come to pass, EM may in fact see a significant drop in compensation in the future. You guys make good points

As a med-student, sometimes I feel like I just boarded the titanic. It's depressing.

old_boy
 
old_boy said:
docB and AmoryBlaine-

Thank you for your thoughtful critiques of my argument. Although I'm not entirely convinced that what the doomsdayers of SDN predict will come to pass, EM may in fact see a significant drop in compensation in the future. You guys make good points

As a med-student, sometimes I feel like I just boarded the titanic. It's depressing.

old_boy
Click to expand...
Maybe I'm painting too gloomy of a picture. I can't remember which thread I post what on but I really think that short term we're looking at a ~5-10% drop depending on our CMS payor populations. The reason is that we've been fighting politically to keep ourselves from getting cut and we've been successful over the last several cuts. It looks like it will be our turn on this next round. We'll survive. I continue to think that EM is one of the best places to be in medicine.
 
docB said:
Maybe I'm painting too gloomy of a picture. I can't remember which thread I post what on but I really think that short term we're looking at a ~5-10% drop depending on our CMS payor populations. The reason is that we've been fighting politically to keep ourselves from getting cut and we've been successful over the last several cuts. It looks like it will be our turn on this next round. We'll survive. I continue to think that EM is one of the best places to be in medicine.
Click to expand...

Exactly, no one has a crystal ball and these things are pretty hard to predict accurately. Even with declining reiumbursement medicine still seems to be a pretty good investment if you do the right field.

At some point in the future I worry that the line of decreasing salaries and increasing med school price/debt is going to intersect at a point where doing primary care fields (Peds, FP, Gen IM) is not financially possible. If that point were reached EM could fall soon after. Not in the sense that you would be an idiot to go into it, but in the sense that it might become more like teaching grade school - a field that requires dedication despite criminally low pay.

I do get a little annoyed when we are castigated (on SDN and by our school admins) for thinking about such things. Keep asking these questions, they are vital!
 
In response to zinjanthropus' post about people waiting less time in single payer systems:

More Ontarians seeking U.S. medical care

An article from The Windsor Star (a Canadian newspaper) that states, among other things, that CANADA is transferring their patients to the US and paying for our expensive health care because they can't provide their own fast enough in emergencies.

http://www.canada.com/windsorstar/story.html?id=b2beeb44-af59-4f9e-b372-47cd9e34345a&k=16834

I recommend reading the comments as well.

Here's the first one:
"I believe that Windsor should have better facilities to treat patients that need the medical attention at the time they need it. My son had an intercraneal brain hemorrhage ( aneurysm ) about a month ago and ther was nothing here available to treat him. London and Toronto were both unable to take him. Childrens Hospital in Detroit was able to take and treat my son and today my son is back in school and able do everything he did in the past. I am very greatfull that we can work together with the hospitals in the U.S."

There are a number of nurses in our ED who live in Canada and talk about what a frustrating, slow system it is. One of them has a father with suspected colon cancer, but he has had to wait two months for a scheduled CT to stage the cancer because the spots for non-emergent CT scans are so limited in Canada. Who knows what his cancer is doing in the meantime. If they could afford it, they'd bring him to the US, present to any ED with a chief complaint of "abdominal pain" and have a CT scan done and read by a radiologist within eight hours.

I think it would be great for everyone to be covered for healthcare (and for everyone who can, to work and help pay for said healthcare), but I don't really think we're that much smarter than Canada.
 
docB said:
Maybe I'm painting too gloomy of a picture. I can't remember which thread I post what on but I really think that short term we're looking at a ~5-10% drop depending on our CMS payor populations. The reason is that we've been fighting politically to keep ourselves from getting cut and we've been successful over the last several cuts. It looks like it will be our turn on this next round. We'll survive. I continue to think that EM is one of the best places to be in medicine.
Click to expand...

Well, there is small hope of a nice "increase" in salary in the near future. There is legislation in the works to make all non-reimbursed and/or delinquent billing tax deductible. That would be a nice pay increase, especially in academics.
 
ditch doctor said:
Well, there is small hope of a nice "increase" in salary in the near future. There is legislation in the works to make all non-reimbursed and/or delinquent billing tax deductible. That would be a nice pay increase, especially in academics.
Click to expand...
That would be nice but I can't see it really happening unless the next election goes down differently than it seems it will.
 
AmoryBlaine said:
At some point in the future I worry that the line of decreasing salaries and increasing med school price/debt is going to intersect at a point where doing primary care fields (Peds, FP, Gen IM) is not financially possible.
Click to expand...

Wow, that's a good point and it would be a real tragedy as primary care is what keeps our society (relatively) healthy. It qualitatively seems like there already aren't enough primary care docs . . . often people tell me "I came to the Ed because I couldn't get an appointment with my regular doctor." If I wanted to be a family doctor I don't see how I could do it having paid my way through 4 years of private medical school (160,000 just in tuition, then add what it costs to live).
 
dr. blue said:
i actually think the em salary will go up (at first) when we socialize. notice i didn't say if, because no matter what anyone says, this wagon's broke. even if obama gets elected, we're probably looking at more change than there has been in the last 8 years.
Click to expand...

I've heard this argument multiple times and I do not agree. Just because something is broken, doesn't mean it will be fixed. And the extent of brokenness does not portend the likelhood of resolution.
 
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