Actual Starting Salaries

[deleted941485]

House leader aims for surprise billing deal by Presidents Day

House Majority Leader Steny Hoyer (D-Md.) said he wants to move on a surprise billing deal as early as mid-February if committee leaders can work out their differences.

www.modernhealthcare.com

Speaking of paying what you owe.

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[EctopicFetus]

Here is what I find perhaps most interested. If we get the ACEP and most other doc solution which is the IDR in NY they have seen a 9% drop in average commercial payments. Talk about insanity. I dont know what will come of the BB legistlation. I do know that the overall sentiment is not positive toward docs. No one feels bad for us. Speaking to a slew of RCM companies and leaders in this topic many seem to have accepted that things will turn out poorly for us. I dont know the nationwide data but the few sites I do know have somewhere from 20-30% commercial payers. They make up about 50% of their revenue. That means best case we are looking at a 5% cut.

On top of this with the changes CMS is considering we could be looking at another 7% from Medicare in 2021.

This isnt me and my opinion. The CMS thing is directly from CMS and of course ACEP is fighting against this. The IDR is from the NY data. We could see a 6% cut in our pay.. its not huge or completely crippling but you know private equity isnt about to lose their “fair” share.

 

[deleted547339]

Oh please spare me the piety and self righteous nonsense.

Getting out of paying what you owe is a distinctly American tradition and it should be embraced from time to time.

It’s not piety and self-righteous nonsense. It’s me being pissed off that I paid more than the median family income in federal taxes and some chunk of that is going to cover up people’s poor life choices. I have less money to put in my kids college fund because I am paying off other people’s bar tab and new shoes from when they went to school. That’s BS.

And if you think there is anything American about not keeping your promises, you should consider living elsewhere.

 

[Dr Mantis Toboggan]

It’s not piety and self-righteous nonsense. It’s me being pissed off that I paid more than the median family income in federal taxes and some chunk of that is going to cover up people’s poor life choices. I have less money to put in my kids college fund because I am paying off other people’s bar tab and new shoes from when they went to school. That’s BS.

And if you think there is anything American about not keeping your promises, you should consider living elsewhere.

Yeah PSL for “non profit” doctors is a pet peeve of mine too.

I’d be OK with it for military (who get school paid for anyway typically) and true public health/public service docs (CDC, IHS, state and city health clinic docs etc).

It’s ridiculous to not have income caps on it, so the docs staying at their fancy university 501c hospital get their loans forgiven making 200-600 depending on specialty or whatever.

But it is what it is. Once the feds start giving stuff away, it pretty much never gets taken back.

 

[Arcan57]

One thing you can do is try to get the actual collections numbers for your site. It's ammunition you can use in negotiations with the new group to justify your demands. Remember the new group needs most of the old docs to stay to keep the place fully staffed. If you band together and make reasonable demands, you will likely get some of them. Just be prepared to walk if they refuse to compromise.

I wouldn't expect a dramatic pay cut on the front end. A contract is only good if you have the docs to staff it so SOP is to avoid rocking the boat unless there's an entire shop worth of docs available to immediately credential. Once you keep the docs, then you can let pay drift down and fill in deserter's positions with new grads in a gradual process. Bonus if it's RVU based because the docs that leave will create temporary productivity spikes as remaining docs pick up the slack. If you time it right, you can bring in a new doc just as your existing docs are getting burnt on the volume and everyone's so relieved not to be killing themselves every shift that the fact that the pay is a $5-15/hr less doesn't sting as much.

 

[EctopicFetus]

I agree it will

I wouldn't expect a dramatic pay cut on the front end. A contract is only good if you have the docs to staff it so SOP is to avoid rocking the boat unless there's an entire shop worth of docs available to immediately credential. Once you keep the docs, then you can let pay drift down and fill in deserter's positions with new grads in a gradual process. Bonus if it's RVU based because the docs that leave will create temporary productivity spikes as remaining docs pick up the slack. If you time it right, you can bring in a new doc just as your existing docs are getting burnt on the volume and everyone's so relieved not to be killing themselves every shift that the fact that the pay is a $5-15/hr less doesn't sting as much.

I agree it will be gradual but stepwise. Frankly how many of us would leave if our pay got cut $5-10/hr especially if you have been at the site for 2-3 years.
IMO very few. That’s what we will see. Oh and more mlps. Saw a th site today. 48 md hours and 60 mlp hours. Insane. That 60 mlp hours is probably 30-40 md hours they don’t need to staff anymore.

 

[GeneralVeers]

I agree it will

I agree it will be gradual but stepwise. Frankly how many of us would leave if our pay got cut $5-10/hr especially if you have been at the site for 2-3 years.
IMO very few. That’s what we will see. Oh and more mlps. Saw a th site today. 48 md hours and 60 mlp hours. Insane. That 60 mlp hours is probably 30-40 md hours they don’t need to staff anymore.

I just quit a Vituity job because they cut the salary $10/hr. They also cut coverage and wanted us to see more patients (not on RVU pay).

 

[miacomet]

I just quit a Vituity job because they cut the salary $10/hr. They also cut coverage and wanted us to see more patients (not on RVU pay).

Isn't Vituity "democratic?" Why the cut?

 

[GeneralVeers]

Isn't Vituity "democratic?" Why the cut?

Because the site was losing money, and rather than the "Partners" taking a haircut on their 20% that they siphon off the site, they chose to cut the doctors' hours and salary.

 

[ERDude]

I guess that’s a kind of interesting thing about being partner in an SDG...my hourly salary has varied by more than $10/hour over each of the past several years (going up some, down others). The economics can swing a decent amount based on partner retirements or additions, new hires, higher than anticipated revenues, etc...

Now they aren’t pay cuts or raises bc it’s a partnership but a different perspective to consider.

 

[GeneralVeers]

I guess that’s a kind of interesting thing about being partner in an SDG...my hourly salary has varied by more than $10/hour over each of the past several years (going up some, down others). The economics can swing a decent amount based on partner retirements or additions, new hires, higher than anticipated revenues, etc...

Now they aren’t pay cuts or raises bc it’s a partnership but a different perspective to consider.

There's a difference though. If you join an SDG and aren't a "partner" your salary should be consistent. Only the partners should have variable salary based on the collections and volume. Vituity was doing it differently. They were modifying the non-partner doctor hours and salary to maintain their 20% bonus. In my opinion it's the vested partners who should take a financial hit if a site is unprofitable, not the non-vested pit docs.

 

[ERDude]

There's a difference though. If you join an SDG and aren't a "partner" your salary should be consistent. Only the partners should have variable salary based on the collections and volume. Vituity was doing it differently. They were modifying the non-partner doctor hours and salary to maintain their 20% bonus. In my opinion it's the vested partners who should take a financial hit if a site is unprofitable, not the non-vested pit docs.

Oh yah I totally agree with that.

Our particular group only hires docs as partnership track there aren’t permanent employee physicians. But yah the pre-partners and APPs etc certainly have a defined rate that isn’t affected by group revenue.

 

[EctopicFetus]

Most people won’t quit for $10/hr. Veers seemingly it wasn’t just the money but the work harder part too that influenced you.
If it was just the money would you have quit? Was that your main gig of just pt? Curious about the facts.

 

[emergentmd]

There's a difference though. If you join an SDG and aren't a "partner" your salary should be consistent. Only the partners should have variable salary based on the collections and volume. Vituity was doing it differently. They were modifying the non-partner doctor hours and salary to maintain their 20% bonus. In my opinion it's the vested partners who should take a financial hit if a site is unprofitable, not the non-vested pit docs.

The only way they will take a pay cut is if they start having a hard time getting good doctors. If they cut by $10/hr, and still have a line of good doctors wanting the job then watch it will be $20. They will keep cutting until it starts being difficult to keep good docs then they will start cutting their salary.

SDG is no different in many ways than CMGs. They will cut the non partners pay, hire more MLPs, cut doc hours until they can't get any more blood.

 

[EctopicFetus]

The only way they will take a pay cut is if they start having a hard time getting good doctors. If they cut by $10/hr, and still have a line of good doctors wanting the job then watch it will be $20. They will keep cutting until it starts being difficult to keep good docs then they will start cutting their salary.

SDG is no different in many ways than CMGs. They will cut the non partners pay, hire more MLPs, cut doc hours until they can't get any more blood.

I guess we are doc heavy and partner heavy. Our sdg has only gotten more generous with mlps and our non partners. That track though is fixed. Who knows.

 

[TooMuchResearch]

Ours is similar. We have a couple of moonlighting fellows (not from our institution) that aren't technically partnership track but will get some credit towards it if they decide to stay on. Everyone else is partner or on track to become one. Partners greatly outnumber employed physicians. Employed physician pay is fixed and written into the agreement. There is nothing in there about needing to adjust pay for any reason other than scheduled increases.

Oh yah I totally agree with that.

Our particular group only hires docs as partnership track there aren’t permanent employee physicians. But yah the pre-partners and APPs etc certainly have a defined rate that isn’t affected by group revenue.

 

[Porfirio]

Most people won’t quit for $10/hr. Veers seemingly it wasn’t just the money but the work harder part too that influenced you.
If it was just the money would you have quit? Was that your main gig of just pt? Curious about the facts.

I’d find a new shop that day. $17,000+ less... so new job would be instant $17,000+ raise and the potential for sign on bonus ($30-40k or more) with moving allowance ($5-10k) with maybe loan repayment.

Yep, that day.

 

[bougiecric]

Here's what's happening in Houston currently. Large hospital system fired a local group a few months ago and signed with a new group. Yesterday, that new group gave the docs their contract if they want to stay on board: ~$50/hr pay cut.

The bottom is falling out.

 

[swamprat]

Here's what's happening in Houston currently. Large hospital system fired a local group a few months ago and signed with a new group. Yesterday, that new group gave the docs their contract if they want to stay on board: ~$50/hr pay cut.

The bottom is falling out.

If only they all came together and no one signed...

 

[Dr Mantis Toboggan]

It’s crazy how fast the gold rush in Houston/Texas came to an end. Definitely feel bad for those docs. Any idea what the rate is now? I mean 450 down to 400 is still amazing. 225 to 175 not so much...

 

[KGflyboy]

If only they all came together and no one signed...

$50/hr pay cut is pretty bad. I understand sticking out a $15/hr pay cut because finding a new job or moving is a big life change. But I don't think I would sign that contract.

 

[TheSingularity]

Here's what's happening in Houston currently. Large hospital system fired a local group a few months ago and signed with a new group. Yesterday, that new group gave the docs their contract if they want to stay on board: ~$50/hr pay cut.

The bottom is falling out.

What CMG took over?

 

[EctopicFetus]

Thats my point. people will stay for a $10 cut.. the issue is the next time will be another 5 and so on and so forth.

Reality is a local shop here got taken over.. $40/hr cut. they were high in the market cause frankly the drive sucks and the system sucks.. they sre still likely paying higher than other local CMGs.what will happen next is the question.

For those of you who say everyone will leave.. welp i got news for you.. you have literally no idea whats going on around you.. Want proof? Look at the rates for pay in denver. $150/hr.. yep.. thats pretty standard.. still takes some effort to get a job. most big cities are fairly full..at some point with the market like this people will work for less and less. Its not like most EM docs have skills where by they can get a job making 200k a year outside of medicine.. now you understand the problem upon us.

 

[bravotwozero]

What CMG took over?

Don’t believe it was a CMG that took over, was the hospital deciding to staff the ED, if my guess is right. If this was a local group, it was the only remaining one - Kelly Larkin’s at St Luke’s hospital. They’re likely all Baylor employees now.


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[GeneralVeers]

Most people won’t quit for $10/hr. Veers seemingly it wasn’t just the money but the work harder part too that influenced you.
If it was just the money would you have quit? Was that your main gig of just pt? Curious about the facts.

It was 50% of my clinical hours. They were already about $40/hour lower than my other job, but it was only a 5 minute commute from my house and they had a really nice cafeteria. It was the combination of less pay, plus harder work that made me quit. I don't mind working harder and seeing more patients, but my salary shouldn't go down at the same time.

 

[Erek94]

Newer attending in Midwest large metropolitan city suburb...Employee FT position about 330k. Also side gig moonlighting in boonies about 2-3 shifts a month brings me to about 430k for the year. Market is getting super tight and were just graduating more and more residents. The graduating residents I supervise are having trouble finding quality jobs close to city, this is the first year I've heard of this being an issue, I hear it's cyclical with job availability but with more programs opening up I don't see this getting better.

 

[ace_inhibitor111]

Where is EM on this curve?

 

[gutonc]

View attachment 294429
Where is EM on this curve?

Probably somewhere between Greed and Fear.

Return to the mean will still probably be ~$200-250/h nationwide average. How long that will take, and how many current SDN members will bail in the interim is TBD.

 

[TheSingularity]

Newer attending currently working in a travel/firefighter position for one of the larger CMG’s. Including extra shifts and some supplemental locums, I earned just over 500k each the past 2 years and am on track for that this year. Up until recently places I worked at could barely fill their schedules. The bonus’s to work extra shifts were insane. I was turning down $350/hr+ on a regular basis.



Fast forward to now.... At 4 sites I’m credentialed at (medium sized cities in Midwest and northeast), 2 of them are now fully staffed and the other 2 are mostly full with only using a few internal locums. Just 2 years ago most of these sites were 2/3 locums.



The CMG is no longer hiring anyone new for the travel position due to the tightening of the market and the less need for internal locums. My job is safe for now but I would imagine they will be cutting reimbursement or laying off. Based on my experience we’re in a lot of trouble.

Gonna go ahead and say you work for Envision.

Anyway, the insidious thing about "internal travel teams" is that they allow the CMGs ultimate control, while undercutting and detsroying the locums market. You have little choice in where you are "deployed." You will be sent to shyt hole EDs, where you must accept whatever combo of garbage medical director / EMR / hospital policies are thrown at you.

So is TH no longer paying for license / DEA fees for their "special ops"? If so this is thousands of dollars in expense for the physician.

 

[Groove]

Yeah, you guys need to quit persuading the med students to pursue EM in here. We need to be talking them all into psych. Stabilize the market forces and bolster our leverage. Any med students that approach me about EM these days...I tell them all the same thing....EM is done for, the sky is falling, only go into EM if they want to throw their career away & get a heart cath 10 years early. I watch that glimmer of hope and joy snuff right out in front of my eyes. They see me scowling but inside...I'm smiling. In the immortal words of Alec Baldwin to his 11 year old daughter...Stay out of EM med students, "don't be a thoughtless little pig!" Let's drive these rates back up over $300/hr.

 

[CCM-MD]

Yeah, you guys need to quit persuading the med students to pursue EM in here. We need to be talking them all into psych. Stabilize the market forces and bolster our leverage. Any med students that approach me about EM these days...I tell them all the same thing....EM is done for, the sky is falling, only go into EM if they want to throw their career away & get a heart cath 10 years early. I watch that glimmer of hope and joy snuff right out in front of my eyes. They see me scowling but inside...I'm smiling. In the immortal words of Alec Baldwin to his 11 year old daughter...Stay out of EM med students, "don't be a thoughtless little pig!" Let's drive these rates back up over $300/hr.

This sort of thinking doesn't really work because the number of residency spots determines the number of grads. Spots aren't going to go empty. You're just going to have less competitive candidates and probably more IMGs.

 

[dav86]

The balance billing bill that is going through our state could completely decimate private hospital based groups. EM, Anesthesia, Rads and Path could be destroyed from a SDG/private group stand point. We will find out in a couple of weeks how it shakes out. Arbitration seems to be off the table, so probably 15-25% pay cuts across the board at best seems likely. If no amendments are added, it could be worse. Hospital employed and CMGs could swoop in within 2-3 years. Another midwest, LCOL, good med Mal state could go to the dark side. Kind of sad and depressing.

 

[Splenda88]

This sort of thinking doesn't really work because the number of residency spots determines the number of grads. Spots aren't going to go empty. You're just going to have less competitive candidates and probably more IMGs.

And a lot of IMG/FMG have no student loan... $100/hr is plenty of money for them. In fact, I heard one said that to one of her PGY3 IM colleagues the other day when they were talking about their hospitalist contracts. She said: '225k/year with no sign on bonus is more than enough for me since I am single with no student loan.' And this is for a fly over state.

 

[Torsion]

This sort of thinking doesn't really work because the number of residency spots determines the number of grads. Spots aren't going to go empty. You're just going to have less competitive candidates and probably more IMGs.

I assumed that post was mostly sarcasm.

As of now EM continues to get more competitive for applicants despite the increase in residencies. I interviewed on mostly established programs this season and don't remember seeing any Caribbean or FMG applicants at all. Very few DO students either. This may be different at some of the new programs cropping up. Based on what senior residents quoted me at some of my interview stops, nobody is having difficulty finding a job they are satisfied with and the offers have been pretty impressive compared to the doom and gloom on this thread.

 

[homebaseddad112818]

I assumed that post was mostly sarcasm.

As of now EM continues to get more competitive for applicants despite the increase in residencies. I interviewed on mostly established programs this season and don't remember seeing any Caribbean or FMG applicants at all. Very few DO students either. This may be different at some of the new programs cropping up. Based on what senior residents quoted me at some of my interview stops, nobody is having difficulty finding a job they are satisfied with and the offers have been pretty impressive compared to the doom and gloom on this thread.

What kind of offers were they getting? Mind elaborating on rangerwhat specifically they were finding?

 

[Groove]

I found these 2 gifs that sum up the future of EM and Psych for potential med students....

= PSYCH


Be warned, if you end up choosing EM, best be prepared to say...KALI MA!

 

[Torsion]

What kind of offers were they getting? Mind elaborating on rangerwhat specifically they were finding?

Best I heard was $500k in Houston. Don't know the specifics of the contract but that blew me away. Another resident in a city 800 miles away turned down a 450k offer because he liked a different contract better. Another program run by an SDG said it used to be difficult getting a job with their group but they've expanded recently. Another SDG I know of hired 20 new docs.

 

[TooMuchResearch]

Which state? PM would be fine...

The balance billing bill that is going through our state could completely decimate private hospital based groups. EM, Anesthesia, Rads and Path could be destroyed from a SDG/private group stand point. We will find out in a couple of weeks how it shakes out. Arbitration seems to be off the table, so probably 15-25% pay cuts across the board at best seems likely. If no amendments are added, it could be worse. Hospital employed and CMGs could swoop in within 2-3 years. Another midwest, LCOL, good med Mal state could go to the dark side. Kind of sad and depressing.

 

[TheSingularity]

Somehow I doubt 500k for new grad in Houston on a standard ~120 hrs/month. That would be $350/hr.

Best I heard was $500k in Houston. Don't know the specifics of the contract but that blew me away. Another resident in a city 800 miles away turned down a 450k offer because he liked a different contract better. Another program run by an SDG said it used to be difficult getting a job with their group but they've expanded recently. Another SDG I know of hired 20 new docs.

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[deleted941485]

Somehow I doubt 500k for new grad in Houston on a standard ~120 hrs/month. That would be $350/hr.

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Complete unbelievable nonsense. Probably some recruiter

 

[EctopicFetus]

The 500k a year thing is a joke. Houston is locked up bad. Pay is $200/hr.
They can tell you whatever. Talk to me after a year. No way that holds.

 

[deleted941485]

The 500k a year thing is a joke. Houston is locked up bad. Pay is $200/hr.
They can tell you whatever. Talk to me after a year. No way that holds.

Don’t worry HCA has a steady stream of IMGs and Med student lemmings add to their dubious training programs to make that 500k nothing more than a drug induced fairy tale

 

[Torsion]

Somehow I doubt 500k for new grad in Houston on a standard ~120 hrs/month. That would be $350/hr.

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For certain more than 120 hrs/month. I think a couple 24 hr shifts/month at a low volume shop were included in that figure. I have a feeling this was the type of resident willing to put some serious hours in at least in his first few years out. Even if you take out the 24s and some extra shifts I would think he'd still be looking at a more lucrative contract than some here would suggest is the new normal.

My experience is anecdotal of course, but the sentiment on SDN that EM is on the fast track to being one of medicine's lowest paying specialties isn't being borne out by what I'm hearing from faculty and residents in person.

 

[TheSingularity]

That's not the sentiment expressed at all.

For certain more than 120 hrs/month. I think a couple 24 hr shifts/month at a low volume shop were included in that figure. I have a feeling this was the type of resident willing to put some serious hours in at least in his first few years out. Even if you take out the 24s and some extra shifts I would think he'd still be looking at a more lucrative contract than some here would suggest is the new normal.

My experience is anecdotal of course, but the sentiment on SDN that EM is on the fast track to being one of medicine's lowest paying specialties isn't being borne out by what I'm hearing from faculty and residents in person.

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[EctopicFetus]

For certain more than 120 hrs/month. I think a couple 24 hr shifts/month at a low volume shop were included in that figure. I have a feeling this was the type of resident willing to put some serious hours in at least in his first few years out. Even if you take out the 24s and some extra shifts I would think he'd still be looking at a more lucrative contract than some here would suggest is the new normal.

My experience is anecdotal of course, but the sentiment on SDN that EM is on the fast track to being one of medicine's lowest paying specialties isn't being borne out by what I'm hearing from faculty and residents in person.

I help place people in jobs. Simply $300/hr doesn’t readily exist. To make 500k you need right about there.
Simply bs. That’s all. Some attendings. Sure. New grads. I call bs.

 

[deleted941485]

For certain more than 120 hrs/month. I think a couple 24 hr shifts/month at a low volume shop were included in that figure. I have a feeling this was the type of resident willing to put some serious hours in at least in his first few years out. Even if you take out the 24s and some extra shifts I would think he'd still be looking at a more lucrative contract than some here would suggest is the new normal.

My experience is anecdotal of course, but the sentiment on SDN that EM is on the fast track to being one of medicine's lowest paying specialties isn't being borne out by what I'm hearing from faculty and residents in person.

I’m sure people path in the 80-90s felt the same way.

Faculty are pretty oblivious to what goes on outside the walls most of the time.

Residents in my experience tend to exaggerate a mediocre offer to impress the others and save face or they genuinely do not understand the contracts they signed.

 

[Torsion]

That's not the sentiment expressed at all.

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I've read someone say on this thread or similar thread that we are headed to avg 120-140/hr. That would be sub 200k annual at 120 hrs/month, an amount EM physicians haven't made in many many years even adjusting down for inflation, and would certainly be among the lowest paid physicians and in the company of some CRNAs and PAs.

Of course as someone new to this business it is difficult to sort through the hyberbole within the doom and gloom to find substantiated realistic numbers.

Faculty are pretty oblivious to what goes on outside the walls most of the time.

I think that could certainly be true for employed ivory tower academics but a good number of the folks I've talked to are partners in SDG run residencies of which there are several in my region.

 

[deleted941485]

I've read someone say on this thread or similar thread that we are headed to avg 120-140/hr. That would be sub 200k annual at 120 hrs/month, an amount EM physicians haven't made in many many years even adjusting down for inflation, and would certainly be among the lowest paid physicians and in the company of some CRNAs and PAs.

Of course as someone new to this business it is difficult to sort through the hyberbole within the doom and gloom to find substantiated realistic numbers.

Look what they did to TKAs in the 90s. It was a freaking wake up call for orthos. Now they lobby like crazy and they get em young telling them how to handle the RUC. Solid work.

 

[EctopicFetus]

I think $200/hr is gonna be the new norm. Likely broadly 180-215/hr. We wont go as low as MLPs. But not too long ago people signed PRN jobs for $300/hr to do fill in work. Thats long gone. Locums has pretty well dried up.

 

[TheSingularity]

The weird thing is I still see an abundance of locums offers but the compensation SUCKS.

I think $200/hr is gonna be the new norm. Likely broadly 180-215/hr. We wont go as low as MLPs. But not too long ago people signed PRN jobs for $300/hr to do fill in work. Thats long gone. Locums has pretty well dried up.

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