Actual Starting Salaries

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Somebody must be taking them...


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

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EctopicFetus said:
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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I would assume the decreasing locums rates are a symptom of supply finally meeting demand in these areas. That was probably due to happen at some point and its probably better for patient care in those outlying hospitals if they are fully staffed with BC emergency docs vs. family practitioners or midlevels.

It would seem to me that the pressing salary concern for your average pit doc would be how much private insurance and CMS is reimbursing rather than locums rates.
 
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This goes coun
Torsion said:
I would assume the decreasing locums rates are a symptom of supply finally meeting demand in these areas. That was probably due to happen at some point and its probably better for patient care in those outlying hospitals if they are fully staffed with BC emergency docs vs. family practitioners or midlevels.

It would seem to me that the pressing salary concern for your average pit doc would be how much private insurance and CMS is reimbursing rather than locums rates.
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This goes counter to basic Econ.
Reality is the cmgs want to pay as little as possible. The uhc thing is simply an excuse.
Consider these 2 scenarios. Cmgs are overrun with applicants. Would they not just drop pay to as low as possible ? Say you owned a contract. You needed 10 docs to work there. You had been paying $200/hr. 300 docs are applying falling over themselves to work for you. The next step is to test the waters at 185 or less and so forth. That’s what is really happening.
Scenario 2. A hospital needs a specific doctor there is 1 person in the world with this qualification. Prices go up up and up. When 50 people are trying to hire that person.
We are entering scenario 1.
 
Even if pay continues to drop, it’s unlikely the salary will ever fall to what a hospitalist would make ($240k), due to the nature of the work. If you take a look at markets like chemical engineering for example, the job market is complete **** with almost 30% of graduates not finding jobs as engineers, but the pay has always been high due to the technicalities of the work. What makes EM worse is that physicians are for the most part interchangeable. There is a huge gap between a good ChemE and a bad one, but all board certified EM physicians are expected to be proficient enough.

More likely what will happen is EM employers will keep salaries above $280k but make the work much more difficult, with unreasonable demands like signing NPs charts. If you don’t keep up, they can easily fire you and get someone younger or more desperate. Physicians will be either forced to move cross country every few years, retire earlier or there will be a growing number of physicians who are underemployed working at UCs or part-time gigs.
 
ace_inhibitor111 said:
Even if pay continues to drop, it’s unlikely the salary will ever fall to what a hospitalist would make ($240k), due to the nature of the work. If you take a look at markets like chemical engineering for example, the job market is complete **** with almost 30% of graduates not finding jobs as engineers, but the pay has always been high due to the technicalities of the work. What makes EM worse is that physicians are for the most part interchangeable. There is a huge gap between a good ChemE and a bad one, but all board certified EM physicians are expected to be proficient enough.

More likely what will happen is EM employers will keep salaries above $280k but make the work much more difficult, with unreasonable demands like signing NPs charts. If you don’t keep up, they can easily fire you and get someone younger or more desperate. Physicians will be either forced to move cross country every few years, retire earlier or there will be a growing number of physicians who are underemployed working at UCs or part-time gigs.
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More and more UCs are staffed by midlevels. I can’t remember the last time I went and there was a doctor.
 
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ace_inhibitor111 said:
Even if pay continues to drop, it’s unlikely the salary will ever fall to what a hospitalist would make ($240k), due to the nature of the work. If you take a look at markets like chemical engineering for example, the job market is complete **** with almost 30% of graduates not finding jobs as engineers, but the pay has always been high due to the technicalities of the work. What makes EM worse is that physicians are for the most part interchangeable. There is a huge gap between a good ChemE and a bad one, but all board certified EM physicians are expected to be proficient enough.

More likely what will happen is EM employers will keep salaries above $280k but make the work much more difficult, with unreasonable demands like signing NPs charts. If you don’t keep up, they can easily fire you and get someone younger or more desperate. Physicians will be either forced to move cross country every few years, retire earlier or there will be a growing number of physicians who are underemployed working at UCs or part-time gigs.
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Market forces can do a lot of things. You never know what desperate people would do...
 
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Splenda88 said:
Market forces can do a lot of things. You never know what desperate people would do...
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The naysayers are so afraid of the bottom dropping out they’ll tell themselves whatever to fall asleep at night. Physicians need to flex hard these days to get the monkey of our backs (admin insurance govt etc) start taking a hard line
 
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EctopicFetus said:
This goes coun

This goes counter to basic Econ.
Reality is the cmgs want to pay as little as possible. The uhc thing is simply an excuse.
Consider these 2 scenarios. Cmgs are overrun with applicants. Would they not just drop pay to as low as possible ? Say you owned a contract. You needed 10 docs to work there. You had been paying $200/hr. 300 docs are applying falling over themselves to work for you. The next step is to test the waters at 185 or less and so forth. That’s what is really happening.
Scenario 2. A hospital needs a specific doctor there is 1 person in the world with this qualification. Prices go up up and up. When 50 people are trying to hire that person.
We are entering scenario 1.
Click to expand...

I know how basic economics works. The argument you are making is really against contracting with a CMG or being in an employed position where you don't eat what you kill. The CMGs and hospital systems in these desirable areas must be making a killing skimming off the top. If, however, you had the opportunity to buy into a SDG partnership I would think your earnings are dependent on your own production. I've certainly heard of SDGs in desirable cities continuing to do very well while employed gigs nearby pale in comparison.

Is there really such a glut of board certified emergency physicians that demand for jobs is exceeding demand for docs?
 
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Torsion said:
I know how basic economics works. The argument you are making is really against contracting with a CMG or being in an employed position where you don't eat what you kill. The CMGs and hospital systems in these desirable areas must be making a killing skimming off the top. If, however, you had the opportunity to buy into a SDG partnership I would think your earnings are dependent on your own production. I've certainly heard of SDGs in desirable cities continuing to do very well while employed gigs nearby pale in comparison.
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Indeed. Sdgs risk is in their contracting and legistlation. What happens with cmgs is irrelevant to them.
Sdgs are the golden goose. Usually better work environment, control, and better pay.
The cmgs bought a lot of them. Few exist and often the buy in is steep. With that steep buy in comes risk. If you have been around you know someone who was a non partner when their sdg sold to cmg and they got nothing of near nothing. Buddy of mine got 30k. Partners got $1m+
 
EctopicFetus said:
Indeed. Sdgs risk is in their contracting and legistlation. What happens with cmgs is irrelevant to them.
Sdgs are the golden goose. Usually better work environment, control, and better pay.
The cmgs bought a lot of them. Few exist and often the buy in is steep. With that steep buy in comes risk. If you have been around you know someone who was a non partner when their sdg sold to cmg and they got nothing of near nothing. Buddy of mine got 30k. Partners got $1m+
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Sale of the SDG while a non-partner working sweat equity would certainly be my biggest fear. I would think there would eventually be a point where the rates offered by the prospective buyer got too low to make selling financially lucrative. If you were a year or 2 from retirement a $1 million dollar buyout would be a gift. If you were a young partner and still had 20 or more years of career left a loss of ~100k year income as an employed doc would cost you more than the buyout would provide.
 
Torsion said:
Sale of the SDG while a non-partner working sweat equity would certainly be my biggest fear. I would think there would eventually be a point where the rates offered by the prospective buyer got too low to make selling financially lucrative. If you were a year or 2 from retirement a $1 million dollar buyout would be a gift. If you were a young partner and still had 20 or more years of career left a loss of ~100k year income as an employed doc would cost you more than the buyout would provide.
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Yep and? Also often it’s well over 100k/yr you are losing.
 
I get calls daily to cover Locum shifts in a Major Texas city. Base is $325/hr and turn down bonuses on a daily bases for $4K to cover these shifts. Too bad my wife didn't want me to travel much or I could make 100K some months.

Some shifts I was pulling over 800/hr when they were really desperate and paying 2.5x rate. I remember a holiday shift when they asked me to name my price but My wife would not have it.

Just did a shift yesterday and shift was super slow. Saw 14 pts in a 12 hr shift and pulled in 8K. Had time to watch the news and saw Trump just win the republican nomination. New England won another superbowl and Royals won the World series. Pretty good year.

The good old days, but good memories. No way I do locums at the current rate I am getting. Still shifts out there but young docs snatch shifts up quicker than I can delete them and 4 yrs ago there were 30 open shifts that was never picked up without a bonus.

Oh well, I am too far into my career to work my butt off at a dysfunctional site for the $275 being offered. Newly minted docs are jumping at them but no way am I getting crushed at that rate. Good luck to all the new grads. Lower rates at crappy hospitals are not too bad when you have no frame of reference.
 
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Torsion said:
I would assume the decreasing locums rates are a symptom of supply finally meeting demand in these areas. That was probably due to happen at some point and its probably better for patient care in those outlying hospitals if they are fully staffed with BC emergency docs vs. family practitioners or midlevels.

It would seem to me that the pressing salary concern for your average pit doc would be how much private insurance and CMS is reimbursing rather than locums rates.
Click to expand...
Depends.
SDG? (Not a predatory one.) Then yes, it's based on how much insurance pays. Why would we pay ourselves less? What would we do with the rest of the money?

CMG? They'll pay you as little as possible as it leaves more money for those that provide no value to get paid.
 
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emergentmd said:
I get calls daily to cover Locum shifts in a Major Texas city. Base is $325/hr and turn down bonuses on a daily bases for $4K to cover these shifts. Too bad my wife didn't want me to travel much or I could make 100K some months.

Some shifts I was pulling over 800/hr when they were really desperate and paying 2.5x rate. I remember a holiday shift when they asked me to name my price but My wife would not have it.

Just did a shift yesterday and shift was super slow. Saw 14 pts in a 12 hr shift and pulled in 8K. Had time to watch the news and saw Trump just win the republican nomination. New England won another superbowl and Royals won the World series. Pretty good year.

The good old days, but good memories. No way I do locums at the current rate I am getting. Still shifts out there but young docs snatch shifts up quicker than I can delete them and 4 yrs ago there were 30 open shifts that was never picked up without a bonus.

Oh well, I am too far into my career to work my butt off at a dysfunctional site for the $275 being offered. Newly minted docs are jumping at them but no way am I getting crushed at that rate. Good luck to all the new grads. Lower rates at crappy hospitals are not too bad when you have no frame of reference.
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Exactly. I just talked with my buddy in Texas. He had a job (maybe with you) and would go to a border town and make 6-800/hr. Said he hasn’t done it in 3 years. Rates dried up. Now does no locums as pay/travel ratio isn’t very good.
 
EctopicFetus said:
Exactly. I just talked with my buddy in Texas. He had a job (maybe with you) and would go to a border town and make 6-800/hr. Said he hasn’t done it in 3 years. Rates dried up. Now does no locums as pay/travel ratio isn’t very good.
Click to expand...

I had exactly the same experience. Rates were great until 2 years ago, with tasty bonuses at least 2X per month for last minute shifts. That dried up so I quit locums. For nearly the same money would rather sleep in my own bed, and not deal with the stress of airline delays, and not getting the First class upgrades.
 
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Since people want to know actual starting salaries for new grads... 240-250 per hour at a local ER near where I'm finishing up residency. IC position for a CMG with malpractice and tail benefits only. Contracted for 120 hours per month but "full time" staffing means there are usually a smattering of shifts left over for the full time staff to pick up a few extra shifts every month if they want them, otherwise they go to some locums people who are paid the same as we are.

Yeah, everybody got excited back when it was bass fishing season and everybody showed their biggest catches (I made 800 per hour on Christmas Day in BFE because they didn't have anybody) but what I expect is that average pay hasn't actually changed in a significant way, though I also don't expect to be paid any more than I'm going to be paid starting July in my career. Save a third of my money and have the option to walk away as soon as possible.
 
CliveStaples said:
Since people want to know actual starting salaries for new grads... 240-250 per hour at a local ER near where I'm finishing up residency. IC position for a CMG with malpractice and tail benefits only. Contracted for 120 hours per month but "full time" staffing means there are usually a smattering of shifts left over for the full time staff to pick up a few extra shifts every month if they want them, otherwise they go to some locums people who are paid the same as we are.

Yeah, everybody got excited back when it was bass fishing season and everybody showed their biggest catches (I made 800 per hour on Christmas Day in BFE because they didn't have anybody) but what I expect is that average pay hasn't actually changed in a significant way, though I also don't expect to be paid any more than I'm going to be paid starting July in my career. Save a third of my money and have the option to walk away as soon as possible.
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Unless you dont have debt you better save a whole lot more than that. 1/3 for taxes. That leaves 160/hr for loans living and retirement. That’s not super high if you want to have fu money unless you leave on the cheap. Can it be long before emcare and others follow the Th lead?
 
I’m FM and my 15k volume job 40 minutes outside of St Louis is $240/hr. My sleepy 15 pt’s in 24 hours job is $185. The world is not ending.
 
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CliveStaples said:
Since people want to know actual starting salaries for new grads... 240-250 per hour at a local ER near where I'm finishing up residency. (...)

(...) but what I expect is that average pay hasn't actually changed in a significant way, though I also don't expect to be paid any more than I'm going to be paid starting July in my career. Save a third of my money and have the option to walk away as soon as possible.
Click to expand...

sounds good and about the same options I had graduating residency 5 years ago. FWIW regarding Ectopic's post; my effective tax rate after maxing SEP IRA is about 19% rather than the stated 33%. Location matters.

With that tax rate and an income of $30-35k/mo you can live very well while investing $150k+ a year.
 
e30ftw said:
sounds good and about the same options I had graduating residency 5 years ago. FWIW regarding Ectopic's post; my effective tax rate after maxing SEP IRA is about 19% rather than the stated 33%. Location matters.

With that tax rate and an income of $30-35k/mo you can live very well while investing $150k+ a year.
Click to expand...
Are you including Social security and medicare (both sides)? Also state income tax if your state has it.

Every state is different.. but I would bet you pay more than 19% when it comes to all those taxes.

Simply lets assume a no state income tax state (Fl, Alaska, TN, TX, NV, etc). At a modest income of 300k married..

in 2019 you will pay about 16,500 in social security and medicare (capped income of about 133k). Then another 2.9% (medicare on 67k) and then another 3.8% on money between 200 and 300k.

So thats another 1k plus another 4k.. So before you pay federal tax you are at 21.5K in Medicare and social security.

With standard deduction you would have another 80k in taxes.. Oddly that gets you right at 100k or 1/3.

Now you can lower this with some retirement etc. Keep in mind I assumed married, I assumed income at 300k, no state income tax and no kids.

taxfoundation.org

How the TCJA's Expiration Will Affect You

Unless Congress acts, Americans are in for a tax hike in 2026.
taxfoundation.org taxfoundation.org

Surely I cant be accurate cause of deductions, location etc. But 1/3 as a 1099 isnt terribly far off.
 
I've been measuring how much fed and state tax I pay each year. If you use a simple formula of
(fed tax paid) / (deposits in your bank account)
and
(state tax paid) / (deposits in your bank account)

None of this adjusting things or using AGI....

As a percentage of income I've paid 22% in fed taxes and 7.5% in state taxes. From everything I've heard that is pretty good, albeit not great.
 
29.5%. Does that include social security etc? Again 1/3 is a rough estimate. I’m a w-2 and just do a flat % of income.
 
EctopicFetus said:
29.5%. Does that include social security etc? Again 1/3 is a rough estimate. I’m a w-2 and just do a flat % of income.
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Does social security show up on your fed tax return? If so, it's included.

I am a 1099 but at the end of the day we all pay taxes one way or another.
 
thegenius said:
Does social security show up on your fed tax return? If so, it's included.

I am a 1099 but at the end of the day we all pay taxes one way or another.
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It’s a separate line item. It’s collected and accounted differently. As a 1099 you pay employer and employee portions of ss and Medicare.
As an example. 2 docs make 200k each. All other things being equal the w-2 doc will bring home more money than the 1099. There are a ton of benefits to 1099 but Medicare and ss aren’t one of them.
Yes there are ways to lower your income and you have control etc. my point is all things being equal w-2 will take more home. The closer you get to the ~130k the greater the % difference.
 
Northeast
Community Academic
$200/hr (goes up with each year experience) + health insurance + nice retirement contribution
Busy AF, but staffed to the gills (7-8 attendings on by noon)
Great EMR
Strong leadership

Location, Pay, Job quality. Pick 2 out of 3. In this case, I think I have 2.5 / 3.

Wife makes ~$240K/yr. We are more than comfortable.
 
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TheSingularity said:
Northeast
Community Academic
$200/hr (goes up with each year experience) + health insurance + nice retirement contribution
Busy AF, but staffed to the gills (7-8 attendings on by noon)
Great EMR
Strong leadership

Location, Pay, Job quality. Pick 2 out of 3. In this case, I think I have 2.5 / 3.

Wife makes ~$240K/yr. We are more than comfortable.
Click to expand...
You can pretty much live on your wife's salary and achieve FIRE in 10 yrs.
 
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Splenda88 said:
You can pretty much live on your wife's salary and achieve FIRE in 10 yrs.
Click to expand...
1580861059485.png
 
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TheSingularity said:
$200/hr (goes up with each year experience)
Click to expand...

That's hilarious! Did a bunch of your old geezer partners sit around and hatch that idea during poker night? "We'll teach those young fellas!" (In my best old voice)

The older, slower and sicker you get...the more you get paid. Man, I need to come work for you guys in about 20 years after I get my prostate out, am wearing perma depends and have gotten both hips replaced.

Older = RICHER. Your group will become the elephant graveyard for EM docs. You'll have a pile of applications a mile high, all of them over the age of 65. LOL, brilliant. One thing is for certain, none of you guys will be in that E-Trade commercial.

 
Groove said:
That's hilarious! Did a bunch of your old geezer partners sit around and hatch that idea during poker night? "We'll teach those young fellas!" (In my best old voice)

The older, slower and sicker you get...the more you get paid. Man, I need to come work for you guys in about 20 years after I get my prostate out, am wearing perma depends and have gotten both hips replaced.

Older = RICHER. Your group will become the elephant graveyard for EM docs. You'll have a pile of applications a mile high, all of them over the age of 65. LOL, brilliant. One thing is for certain, none of you guys will be in that E-Trade commercial.

Click to expand...

Pretty sure they mean that the pay goes up with each year of experience worked AT THAT SITE. Your interpretation would pose obvious problems as you pointed out.
 
Not really.

The older guys pull their weight and are a great resource to boot.
Groove said:
That's hilarious! Did a bunch of your old geezer partners sit around and hatch that idea during poker night? "We'll teach those young fellas!" (In my best old voice)

The older, slower and sicker you get...the more you get paid. Man, I need to come work for you guys in about 20 years after I get my prostate out, am wearing perma depends and have gotten both hips replaced.

Older = RICHER. Your group will become the elephant graveyard for EM docs. You'll have a pile of applications a mile high, all of them over the age of 65. LOL, brilliant. One thing is for certain, none of you guys will be in that E-Trade commercial.

Click to expand...


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This is exactly why pay should be RVU based and not experienced based. Experience does increase RVU production but only to a point. There's a rapid drop-off in productivity for doctors over 50. I've worked with a few in their 70's who could barely see 1pph and had no business being employed in a busy ED.
 
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GeneralVeers said:
This is exactly why pay should be RVU based and not experienced based. Experience does increase RVU production but only to a point. There's a rapid drop-off in productivity for doctors over 50. I've worked with a few in their 70's who could barely see 1pph and had no business being employed in a busy ED.
Click to expand...

Definitely need a better exit strategy for aging EM docs, that's for sure. I work with one woman in her mid-sixties who is faster than any of us, although she doesn't do nights.
 
I can only think of a small handful in our group that are over 50.
GeneralVeers said:
This is exactly why pay should be RVU based and not experienced based. Experience does increase RVU production but only to a point. There's a rapid drop-off in productivity for doctors over 50. I've worked with a few in their 70's who could barely see 1pph and had no business being employed in a busy ED.
Click to expand...
 
One does part time occ med, one does a lot of international work but I don't think he gets paid, at least one just flat out retired from medicine but was at least 65.

Or do you mean what do our docs still working after 50 do? Nothing different than the rest of us. Our group doesn't have a glide path. Another local group that wasn't the right fit for me does have a glide path: small hour reduction every couple of years (or you could read that as a small raise) with no nights after 50 or 55. We have enough nocturnists now such that my nights are pretty limited, but now it's a lot of freaking evening shifts.
miacomet said:
What do they do after 50?
I'd say one third of our docs are over fifty.
Click to expand...
 
Torsion said:
Is there really such a glut of board certified emergency physicians that demand for jobs is exceeding demand for docs?
Click to expand...

I don't think there is a glut of BCEM. However much of the work in is being done by NPs and PAs, and in the smaller / harder to recruit to areas, FP and IM physicians. Essentially the market for BCEM is shrinking.
 
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MechEDoc said:
I don't think there is a glut of BCEM. However much of the work in is being done by NPs and PAs, and in the smaller / harder to recruit to areas, FP and IM physicians. Essentially the market for BCEM is shrinking.
Click to expand...

Here's what I don't get. Say a hospital / contract holder is cheap and uses non-BCEM and there is an adverse outcome (for argument's sake, an error of omission with regards to bread and butter EM). Lawsuits seem to be generally targeted against the individual physician or mid-level. However, the contracting entity (SDG, CMG, etc.) hired the person and the hospital credentialed them. I can't wrap my head around why this isn't a salient point in lawsuits seeking greater damages. I would like to think that there is a real gold mine there from a litigation standpoint...
 
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TheSingularity said:
Northeast
Community Academic
$200/hr (goes up with each year experience) + health insurance + nice retirement contribution
Busy AF, but staffed to the gills (7-8 attendings on by noon)
Great EMR
Strong leadership

Location, Pay, Job quality. Pick 2 out of 3. In this case, I think I have 2.5 / 3.

Wife makes ~$240K/yr. We are more than comfortable.
Click to expand...

Oh forgot to mention, no night shifts.

But you can continue to go off on people with more experience than me making slightly more money.
 
MechEDoc said:
Here's what I don't get. Say a hospital / contract holder is cheap and uses non-BCEM and there is an adverse outcome (for argument's sake, an error of omission with regards to bread and butter EM). Lawsuits seem to be generally targeted against the individual physician or mid-level. However, the contracting entity (SDG, CMG, etc.) hired the person and the hospital credentialed them. I can't wrap my head around why this isn't a salient point in lawsuits seeking greater damages. I would like to think that there is a real gold mine there from a litigation standpoint...
Click to expand...

If the hospital was sued it seems like the prosecution only need ask "why did you employ people not trained in emergency care in your emergency room?" My understanding of the field is that board certification and the development of EM as a unique specialty was in response to a need for docs better trained in emergency care. The rural sites staffed by IM/FM docs have probably always been that way. It seems like a lobbying effort could be undertaken to establish staffing EDs with emergency physicians as standard of care. Per the latest salary survey, it seems like a substantial number of sites still employ IM/FM boarded docs.
 
I see your point but standard of care is often defined by local standards. A lot of these jobs in the sticks are low volume and far from anywhere decent. They barely generate any revenue even taking into account federal $ for critical access hospitals (almost no private insurance etc). Bottom line is someone needs to staff these places as long as the hospital is open (whether it should be or not is another question). The hospitals and CMGs are not getting rich of these places.


MechEDoc said:
Here's what I don't get. Say a hospital / contract holder is cheap and uses non-BCEM and there is an adverse outcome (for argument's sake, an error of omission with regards to bread and butter EM). Lawsuits seem to be generally targeted against the individual physician or mid-level. However, the contracting entity (SDG, CMG, etc.) hired the person and the hospital credentialed them. I can't wrap my head around why this isn't a salient point in lawsuits seeking greater damages. I would like to think that there is a real gold mine there from a litigation standpoint...
Click to expand...
 
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TheSingularity said:
Oh forgot to mention, no night shifts.

But you can continue to go off on people with more experience than me making slightly more money.
Click to expand...
You keep saying "more experience" but does your group actually pay more to new hires who have never worked there, but have been practicing for say 10 years? Or does everyone start at ~200/hr and they pay you more every year that you work there?
 
More for years post residency. Not necessarily for years worked there. I don't mind it I'm happy.
BoardingDoc said:
You keep saying "more experience" but does your group actually pay more to new hires who have never worked there, but have been practicing for say 10 years? Or does everyone start at ~200/hr and they pay you more every year that you work there?
Click to expand...

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