Class of 2021 job market insights

[Emerbeamer]

Yeah and the people displaced from Target and Ross and the local bar have 200-300k in debt too right?

You're a tool

Some of them have debt and no remote potential of every being able to pay. People are stuggling everywhere. You're a tool for thinking doctors in any capacity have it the worst. And you're the reason people have no empathy for our profession.

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[Rekt]

Some of them have debt and no remote potential of every being able to pay. People are stuggling everywhere. You're a tool for thinking doctors in any capacity have it the worst. And you're the reason people have no empathy for our profession.

Did enough people not kiss your feet today? You should change your avatar to that cringey hero crap going around. Medicine is a job. Get over yourself.

 

[Emerbeamer]

Overall, I agree with much of the sentiment in your post. The way economics works, and has worked for centuries, is that huge crashes rebound back over time. We've seen it in the markets even as recently as this past decade. You are correct, things will get better I suspect.

That being said, the current situation is god awful and extremely messed up if you are a graduating resident. You have paid your dues, invested in your education over decades, gotten beaten to a pulp in residency, for the promise that when you get out, you will be able to *hopefully* return the hundreds of thousands of dollars you owe back to the federal government. Maybe provide for your family. Maybe stash away some cash for a rainy day.

Graduating residents shouldn't be placed in the same category as "rich doctors". I feel like the general public often turns a blind eye to physician hardship because they view them as well off. They don't take into account the immense sacrifices, debt incurred, and delayed gratification that goes into being a physician. So you can't compare a physician to say, a medical tech or an RN, or pretty much any other occupation in America.

Your salary dropping to 220/hr is very different than what a new resident is going through where their contract has just been pulled and they don't have a job. While yes, it is the middle of a pandemic, it is also in many ways a commentary on how large groups and the health care system has really taken advantage of physicians.

I agree with you that it sucks. I totally get that. I'm saying that the doom and gloom about the specialty I've seen on the forum is off. This is not an EM problem. If you're coming out of residency in any number of specialties, you're having a hard time finding a job. And this is not a medicine problem. Were in a pandemic. People who were making $10/hr and have debts and obligations cant find jobs. They had no cushion and many have very little earning potential. People are sick and dont have jobs. People who were making 150 K a year in corporate america are layed off. For docs to act like we have it the worst bc we have loans is disingenuous and self important. It speaks to a lack of understanding of the gravity of this crisis and our own privilege. At least as physicians, we have an education and skillset that means that we will come out of this ok. Our jobs will return when the patients return. I firmly believe the patients will come back because I'm already seeing it. Like I said, we came off of a busy year in which we added shifts, to cutting back 33%. Its a sign of the times.

But what about the person whose restaurant and life savings went under? How are they going to come back when the dust settles. What about college grads with debt who cant even get an internship let alone a job? I'm just saying , we got it bad, but we are going to get better. I think thats a better message for residents than "were ****ed were ****ed were ****ed". But hey, if folks want to see it that way, fine.

The way I look at it, the world economy blows. Medicine...all of it...has taken a hit. But if you finished residency you have job prospects and a high earning potential. Even if not right this second.

 

[Emerbeamer]

Did enough people not kiss your feet today? You should change your avatar to that cringey hero crap going around. Medicine is a job. Get over yourself.

God bless you. And I mean that.

 

[Emerbeamer]

I wouldn't make life altering decisions based upon a 8-10 person echo chamber here on SDN. If you go to other forums on here you'll get the same doom and gloom. Anesthesia, for example, has been talked up on this thread. I did a rotation in anesthesia last year. I'd be bored out of my mind in that career. The docs I worked with didn't seem particularly happy, either. But then again, one of them complained ad nauseum about how he hated that deep sea fishing was his hobby because he had to spend money on fuel, and an expensive charter boat (that he owned), and have people help him crew. I don't know about you, but I can't imagine what an inconvenience it must be to have the ability to go gulfstream fishing whenever I want. The horror.

Perspective is key.

THIS

 

[Backpack234]

I suspect you're simply incorrect about what partners are getting paid. What is likely happening is that partners are making 140/hr base + profit sharing.

Just basing this on my experience. I interviewed with a few groups around the country. Even with +profit sharing included, a lot of partners still don’t break 200/hr. this gets a bit more nuanced with benefits packages, but even then.

I just think it’s strange to think an SDG run ER in Virginia can see 100 patients a day with 24 hour doc coverage and pay 225/hr while a similar ER in Denver with 100 pts/day and the same coverage would pay 140/hr (180 with profit share)

 

[ShockIndex]

Just basing this on my experience. I interviewed with a few groups around the country. Even with +profit sharing included, a lot of partners still don’t break 200/hr. this gets a bit more nuanced with benefits packages, but even then.

I just think it’s strange to think an SDG run ER in Virginia can see 100 patients a day with 24 hour doc coverage and pay 225/hr while a similar ER in Denver with 100 pts/day and the same coverage would pay 140/hr (180 with profit share)

What is the payer mix of the 2 hospitals? Also, demand for jobs is probably higher in Denver...I suppose more people like to see mountains while sitting in traffic for hours.

 

[TheComebacKid]

I agree with you that it sucks. I totally get that. I'm saying that the doom and gloom about the specialty I've seen on the forum is off. This is not an EM problem. If you're coming out of residency in any number of specialties, you're having a hard time finding a job. And this is not a medicine problem. Were in a pandemic. People who were making $10/hr and have debts and obligations cant find jobs. They had no cushion and many have very little earning potential. People are sick and dont have jobs. People who were making 150 K a year in corporate america are layed off. For docs to act like we have it the worst bc we have loans is disingenuous and self important. It speaks to a lack of understanding of the gravity of this crisis and our own privilege. At least as physicians, we have an education and skillset that means that we will come out of this ok. Our jobs will return when the patients return. I firmly believe the patients will come back because I'm already seeing it. Like I said, we came off of a busy year in which we added shifts, to cutting back 33%. Its a sign of the times.

But what about the person whose restaurant and life savings went under? How are they going to come back when the dust settles. What about college grads with debt who cant even get an internship let alone a job? I'm just saying , we got it bad, but we are going to get better. I think thats a better message for residents than "were ****ed were ****ed were ****ed". But hey, if folks want to see it that way, fine.

The way I look at it, the world economy blows. Medicine...all of it...has taken a hit. But if you finished residency you have job prospects and a high earning potential. Even if not right this second.

I see what you are saying, and again, agree with much of it.

That being said, imagine tomorrow your medical director calls you and says, "You don't have a job anymore." Would you have a different outlook on the situation?

To me, saying "a lot of people have it WAY worse than me, we should think about all the unemployed janitors" when you are making 220/hr screams of virtue signaling.

I agree. It's bad for everyone. I don't think the argument is that graduating residents have it WORSE than the fast food service worker. But they still have it pretty bad, and we should support them to the fullest.

 

[EctopicFetus]

whoops. I wrote “Denver cmgs pay 140/hr, even after partnership”. I absolutely meant SDGs. There’s no partnership in CMGs. My mistake.

the point I’m trying to make is if your shop is a profit sharing partnership, your partners should be making a split of the revenue minus costs. But for some reason even SDGs in areas with low paying CMGs (like Denver) aren’t paying partners that much.

I’m talking about the disconnect between market hourly rates set by CMGs and partnership rates that should be set by revenues, but aren’t.

Umm how do i break this to you.. Thats not an SDG.. USACS is a CMG even with their partnership. We can argue about vituity but I don’t think they are in Denver.

 

[EctopicFetus]

The thing is yes everyone is taking a hit. SDGs will bounce back. The CMGs will use this crisis to firm up pay cuts. The new grads and MLPs will make it easier for them to accomplish their goals. It’s a business and they are trying to cut their expenses and the biggest expense they have are their labor costs.

 

[Emerbeamer]

I see what you are saying, and again, agree with much of it.

That being said, imagine tomorrow your medical director calls you and says, "You don't have a job anymore." Would you have a different outlook on the situation?

To me, saying "a lot of people have it WAY worse than me, we should think about all the unemployed janitors" when you are making 220/hr screams of virtue signaling.

I agree. It's bad for everyone. I don't think the argument is that graduating residents have it WORSE than the fast food service worker. But they still have it pretty bad, and we should support them to the fullest.

My outlook on the situation is that IT SUCKS, but things will get better and residency grads have the skill and potential to get hired and make good money when things bounce back. That would be my same outlook if I lost my job. Thats been my outlook throughout life when I've been broke, had no job, and have struggled. Delayed gratification and near destitution was my life as a student and resident. Being an attending is the first come up I've ever had. And so my personal outlook is that which I stated. If people find it more helpful to take the more pessimistic view, thats fine. I'm only speaking as someone working now to say to the grads, "things are bad for everyone. but you trained to do a job you'll hopefully love. You've almost crossed the finish line. You have the skill and experience., And the volume is picking up (at my shops), and comparatively speaking that puts you in a decent position at a ****ty time". I'm just saying, this board in general is too negative. And these grads are going to be ok.

I disagree with people who've stated that things wont bounce back etc etc. My view is a more encouraging one, and I wish the best for everyone during this tough time.

 

[alpinism]

There are still quite a few jobs available but for the most part they're all in less than desirable locations.

I still get calls every month about jobs in the midwest paying $200/hr for shifts at rural hospitals.

 

[EMPertinent]

whoops. I wrote “Denver cmgs pay 140/hr, even after partnership”. I absolutely meant SDGs. There’s no partnership in CMGs. My mistake.

the point I’m trying to make is if your shop is a profit sharing partnership, your partners should be making a split of the revenue minus costs. But for some reason even SDGs in areas with low paying CMGs (like Denver) aren’t paying partners that much.

I’m talking about the disconnect between market hourly rates set by CMGs and partnership rates that should be set by revenues, but aren’t.

There are no SDGs left in Denver proper.

 

[deleted814217]

All CMG there or the university. What a shame. UCACS has taken over Colorado it seems like

 

[EctopicFetus]

I don’t think I’m pessimistic. I think it will be fine but ones perception comes from ones experience. I have known multiple em docs who earned over $1m /yr. I’m not one of them.
Their view of their income dropping to 600k is different than someone making 200/hr dropping to 190. The person losing 400k is likely feeling like the sky is falling whereas the one losing $10/hr feels like things will be fine.

I like you came from 0. That being said it’s foolish not to look at the market forces and see that the future isn’t brighter than the past for em as a whole.
Maybe that’s pessimistic I don’t know but I do know it’s honest.

 

[SeekerOfTheTree]

Haven't posted here in years but been lurking through the years. It is bad right now. Even in the midwest it ain't that great. A big academic center cut pay 25% for the year. Another one is cutting up to 50%. It is easy to google them and you will see. PEM departments have been furloughed for the year. Midlevels gone from the last place I worked. Not furloughed but shifts cut forever. Things are changing and I am not seeing the silver lining. Even locums is starting to dry up compared to 2-3 years ago. Things are changing in EM and it is not a bad idea to let residents know. This is the same forum that I use to follow years ago when rates were 400+ and there was a ton of optimism here. I don't remember it always being the doom and gloom.

I have gone for the hospital employed model because I am tired of being sold out to Envision, USACS, Vituity, TH, Alteon, APP. I have worked for almost all of them now. Hospital has invested a ton of money into my loan repayment so I doubt they will sell out to TH tomorrow. I don't know how we change this. More physicians as CEOs of hospitals? How do we even get there? I wish we would come up with a strategy to go into leadership and execute from the top down. Without going into leadership or law making we are hosed.

 

[bravotwozero]

The ED director at my hospital also happens to be the CQO and CMO. Gives us some degree of leverage, but not much....

 

[Modstopizdy]

I see what you are saying, and again, agree with much of it.

That being said, imagine tomorrow your medical director calls you and says, "You don't have a job anymore." Would you have a different outlook on the situation?

To me, saying "a lot of people have it WAY worse than me, we should think about all the unemployed janitors" when you are making 220/hr screams of virtue signaling.

I agree. It's bad for everyone. I don't think the argument is that graduating residents have it WORSE than the fast food service worker. But they still have it pretty bad, and we should support them to the fullest.

I would argue that unemployed residents have it much, much worse than unemployed fast food workers. Both have nothing, but the unemployed residents are down 7 of the best years of the their life while the fast food workers are down 10 minutes of filling out an online application form.

 

[Emerbeamer]

Haven't posted here in years but been lurking through the years. It is bad right now. Even in the midwest it ain't that great. A big academic center cut pay 25% for the year. Another one is cutting up to 50%. It is easy to google them and you will see. PEM departments have been furloughed for the year. Midlevels gone from the last place I worked. Not furloughed but shifts cut forever. Things are changing and I am not seeing the silver lining. Even locums is starting to dry up compared to 2-3 years ago. Things are changing in EM and it is not a bad idea to let residents know. This is the same forum that I use to follow years ago when rates were 400+ and there was a ton of optimism here. I don't remember it always being the doom and gloom.

I have gone for the hospital employed model because I am tired of being sold out to Envision, USACS, Vituity, TH, Alteon, APP. I have worked for almost all of them now. Hospital has invested a ton of money into my loan repayment so I doubt they will sell out to TH tomorrow. I don't know how we change this. More physicians as CEOs of hospitals? How do we even get there? I wish we would come up with a strategy to go into leadership and execute from the top down. Without going into leadership or law making we are hosed.

I get it. But we're in the middle of a pandemic. 38 million people have filed unemployment, and we're just scratching the surface. 38 million! Many of those jobs will never return. Patient volumes have plummeted. Every sector of the economy, including medicine is taking a hit. Every specialty have faced cuts. Lets not conflate pay cuts and PEM furloughs occurring now with different issues pertinent in EM. This isn't an EM problem you're speaking of. And it isn't a medicine one. Nearly everyone in the country has suffered bc of this.

I agree with you that as a separate issue, EM docs need more ownership and less private equity and large group presence. But again, what's happening today is a different beast. Yes, let residents know the general trends in medicine and EM that have occurred over the past decade. But also let residents know that the awful job market of today is a temporary downturn as a result of this pandemic that we're all facing. And bc residents are uniquely trained, they will be ok when we come out of this.

It doesn't mean we don't speak about the challenges and pitfalls of EM in general.

 

[Emerbeamer]

I would argue that unemployed residents have it much, much worse than unemployed fast food workers. Both have nothing, but the unemployed residents are down 7 of the best years of the their life while the fast food workers are down 10 minutes of filling out an online application form.

Really? Speak to some of your patients who work fast food and really think about the struggles they face being at the bottom of the socioeconomic rung with no skills and education to do anything but flip burgers. If we hurt during this, they really hurt. Again, all i sense here is doom and gloom. I never saw residency as being "down the 7 best years" of my life. I was doing something I'd wanted to my whole life. Learning. Making a little money. And outside of work living my life. Seems way better to me than flipping burgers and dropping fries , but hey, just my perspective.

THIS WILL END. Were in the middle of it now. Its temporary. People will keep getting sick. patients will come back (they already are). Residents will find jobs. And the message I'm telling residents is: THIS SUCKSSS. BUT THIS TOO SHALL PASS.

 

[Rekt]

Really? Speak to some of your patients who work fast food and really think about the struggles they face being at the bottom of the socioeconomic rung with no skills and education to do anything but flip burgers. If we hurt during this, they really hurt. Again, all i sense here is doom and gloom. I never saw residency as being "down the 7 best years" of my life. I was doing something I'd wanted to my whole life. Learning. Making a little money. And outside of work living my life. Seems way better to me than flipping burgers and dropping fries , but hey, just my perspective.

THIS WILL END. Were in the middle of it now. Its temporary. People will keep getting sick. patients will come back (they already are). Residents will find jobs. And the message I'm telling residents is: THIS SUCKSSS. BUT THIS TOO SHALL PASS.

You can't have it both ways. You can't say oh residents are fine and everything will bounce back at the same time saying many other jobs are lost forever. Insurance goes with some of those jobs. One insured patient is worth 10-500x much as an uninsured patient. People forget that normal people pay your bills for all the crack heads and malingers that abuse the department. Even losing a small portion of insured patients is a significant loss.

Maybe your view is so skewed from sucking that silver spoon but some of us actually came from poverty. If I was unable to land a job after residency then yes, I would 100x worse off than someone fired from a serving job.

 

[EctopicFetus]

THIS

I'm not gonna get super snide with your comments but just cause others have it worse doesn't mean that the current situation doesn't suck. It also doesn't mean it won't get worse. I am not one to say you should leave EM or anything like that. While some people took a small pay cut others took a lot more. If you have 200k in debt and live a lifestyle of an upper middle-class person having your pay cut to 20k a month pre-tax is gonna sting. That's all. As far as new grads I'll say what I said before, the EM market is more in line with a simple supply/demand market. With an abundance of grads, stagnant volume, and CMGs happily using MLPs the supply side is about to get very fat.

you don't have to agree with my assessment but if you think i am wrong go look at the number of ED visits over the past 2-3 years, the number of MLPs finishing NP and PA school, and the number of EM grads.

You might want to think that those EM docs will push out the EM imposters from rural sites. EM docs don't want to work in those places and frankly the risk is that many of those EM docs will bolt when something "in town" opens up.

 

[Emerbeamer]

You can't have it both ways. You can't say oh residents are fine and everything will bounce back at the same time saying many other jobs are lost forever. Insurance goes with some of those jobs. One insured patient is worth 10-500x much as an uninsured patient. People forget that normal people pay your bills for all the crack heads and malingers that abuse the department. Even losing a small portion of insured patients is a significant loss.

Maybe your view is so skewed from sucking that silver spoon but some of us actually came from poverty. If I was unable to land a job after residency then yes, I would 100x worse off than someone fired from a serving job.

You can’t have it both ways. You don’t know me or my life, but I had a silver spoon? Ignorant comment number one.

Also you can’t tell someone else they had a silver spoon, when you are so self-centered, arrogant and self important to think that a resident not having a job is any worse, more scary, or harder a server (or anyone who’s not rich for that matter) not having a job. You reek of elitism. I hope that you correct this thinking before you take care of people who may come from a different background or situation from you but have very real problems of their own.

Don’t like me saying I think things are gonna be ok ? Fine, sit in your own bull**** and brood and cry. See how it helps you.

As for me and the residents I mentor, In telling them they will be fine in the end. And they have made it too far to think otherwise

 

[Emerbeamer]

I'm not gonna get super snide with your comments but just cause others have it worse doesn't mean that the current situation doesn't suck. It also doesn't mean it won't get worse. I am not one to say you should leave EM or anything like that. While some people took a small pay cut others took a lot more. If you have 200k in debt and live a lifestyle of an upper middle-class person having your pay cut to 20k a month pre-tax is gonna sting. That's all. As far as new grads I'll say what I said before, the EM market is more in line with a simple supply/demand market. With an abundance of grads, stagnant volume, and CMGs happily using MLPs the supply side is about to get very fat.

you don't have to agree with my assessment but if you think i am wrong go look at the number of ED visits over the past 2-3 years, the number of MLPs finishing NP and PA school, and the number of EM grads.

You might want to think that those EM docs will push out the EM imposters from rural sites. EM docs don't want to work in those places and frankly the risk is that many of those EM docs will bolt when something "in town" opens up.

your first paragraph agreed with everything that I said. I already said that it sucks. Multiple times. So we agree there. I also didn’t say that people not having a job makes it suck less. I said that it sucks regardless, but that everyone is suffering now so the problem is not inherent to emergency medicine or medicine in general.

i’m in the specialty. I’m not the enemy. I’m someone who took a humongous pay cut, very similar to the one you just spoke at $20,000 a month. So don’t attack me for speaking optimistically. I’m just saying, just like I can’t predict for certain that things will get it better, you can’t predict for certain things will get worse. And it is my opinion that at least in the short term things will get better. And I’m basing that based on what I’m seeing at multiple hospitals in which I work. That’s it. If you don’t like my point of view that things will get better, so be it. We can agree disagree.

 

[Modstopizdy]

Really? Speak to some of your patients who work fast food and really think about the struggles they face being at the bottom of the socioeconomic rung with no skills and education to do anything but flip burgers. If we hurt during this, they really hurt. Again, all i sense here is doom and gloom. I never saw residency as being "down the 7 best years" of my life. I was doing something I'd wanted to my whole life. Learning. Making a little money. And outside of work living my life. Seems way better to me than flipping burgers and dropping fries , but hey, just my perspective.

THIS WILL END. Were in the middle of it now. Its temporary. People will keep getting sick. patients will come back (they already are). Residents will find jobs. And the message I'm telling residents is: THIS SUCKSSS. BUT THIS TOO SHALL PASS.

Yes really, 120% super doopery really. I don't have to ask any patients who are at the bottom of the socioeconomic spectrum because I've been at the bottom of the socioeconomic spectrum for my entire life. I've worked menial jobs since I was 15 years old and had a decade of such labor under my belt before I even matriculated medical school.

Needless to say, going into massive 300k debt while surviving on a $16k annual living expense budget in medical school did not improve my socioeconomic status one bit from the days of collecting carts off the grocery store parking lot. If I quit now, I'd be far worse off than your average minimum wage worker of my same age. If I go on to finish residency only to end up without a decently lucrative job, my position will be even worse.

The fact any of this stuff is so difficult for you to understand that I have to spell it out in this way, combined with your constant allusions to the supposed "elitism" of everyone here makes me suspect you almost certainly have waltzed through life with a silver spoon in your mouth and find it difficult to comprehend that not everyone here has been as fortunate as you have been. For myself and for many others however, this career is a way to try and grind our way up from the socioeconomic hole we were born into, and at this stage of our training all we've managed to do is dig the hole deeper with the expectation that at the end of it, we'll find some buried gold nuggets that will allow us to buy our way out. If there are no lucrative jobs at the end of this pathway, all we'll have to show for years of digging is being stuck in an even deeper hole. At that point I'd give everything to go back in time and be in the position of an unemployed fast food worker, one who is 7 years younger and 300k less in debt.

 

[EctopicFetus]

your first paragraph agreed with everything that I said. I already said that it sucks. Multiple times. So we agree there. I also didn’t say that people not having a job makes it suck less. I said that it sucks regardless, but that everyone is suffering now so the problem is not inherent to emergency medicine or medicine in general.

i’m in the specialty. I’m not the enemy. I’m someone who took a humongous pay cut, very similar to the one you just spoke at $20,000 a month. So don’t attack me for speaking optimistically. I’m just saying, just like I can’t predict for certain that things will get it better, you can’t predict for certain things will get worse. And it is my opinion that at least in the short term things will get better. And I’m basing that based on what I’m seeing at multiple hospitals in which I work. That’s it. If you don’t like my point of view that things will get better, so be it. We can agree disagree.

Your optimism is based on what though? Thats my question. I laid out why I reached the conclusion I did.

Ill rehash it.

1) ED volumes stagnant tor dropping
2) More and more residents coming out every year
3) More CMGs
4) More MLPs
5) Hospitals and FSEDs being closed faster than new ones being opened
6) Insurance companies coming after us (See United and Teamhealth, United and Envision) and United owning Sound Physicians and being the largest employer of physicians (not EM) in the US
7) The economic impact of COVID will push people off of commercial insurance and wither into no insurance or Medicaid which pays way less.


Walk me thru the optimism..

 

[Emerbeamer]

Yes really, 120% super doopery really. I don't have to ask any patients who are at the bottom of the socioeconomic spectrum because I've been at the bottom of the socioeconomic spectrum for my entire life. I've worked menial jobs since I was 15 years old and had a decade of such labor under my belt before I even matriculated medical school.

Needless to say, going into massive 300k debt while surviving on a $16k annual living expense budget in medical school did not improve my socioeconomic status one bit from the days of collecting carts off the grocery store parking lot. If I quit now, I'd be far worse off than your average minimum wage worker of my same age. If I go on to finish residency only to end up without a decently lucrative job, my position will be even worse.

The fact any of this stuff is so difficult for you to understand that I have to spell it out in this way, combined with your constant allusions to the supposed "elitism" of everyone here makes me suspect you almost certainly have waltzed through life with a silver spoon in your mouth and find it difficult to comprehend that not everyone here has been as fortunate as you have been. For myself and for many others however, this career is a way to try and grind our way up from the socioeconomic hole we were born into, and at this stage of our training all we've managed to do is dig the hole deeper with the expectation that at the end of it, we'll find some buried gold nuggets that will allow us to buy our way out. If there are no lucrative jobs at the end of this pathway, all we'll have to show for years of digging is being stuck in an even deeper hole. At that point I'd give everything to go back in time and be in the position of an unemployed fast food worker, one who is 7 years younger and 300k less in debt.

Woe is you.

I came from nothing too dude. First generation college. Worked my ass off.

You have a hard time understanding that working hard doesn’t make you special. And nobody owes you ****. What does make someone special is having empathy for others and making the best out of the twists and turns life gives us.

I hope things get better. And I think they will. I stand by that. If you don’t like that outlook, you can continue to pontificate about the life of someone on the internet you’ve never met. Have at it.

I remember being down and out from college through residency looking at these message boards, and moments of positivity and encouragement here helped me. So this message goes to the residents. You have a dynamic and lucrative job a head of you. I’m still positive about EM and enjoy what i do in spite of my loans and a 40% pay cut today. This pandemic hurts us, but I’m seeing improvement day by day and I think we are going to bounce back. Keep keeping on, guys.

 

[Emerbeamer]

Your optimism is based on what though? Thats my question. I laid out why I reached the conclusion I did.

Ill rehash it.

1) ED volumes stagnant tor dropping
2) More and more residents coming out every year
3) More CMGs
4) More MLPs
5) Hospitals and FSEDs being closed faster than new ones being opened
6) Insurance companies coming after us (See United and Teamhealth, United and Envision) and United owning Sound Physicians and being the largest employer of physicians (not EM) in the US
7) The economic impact of COVID will push people off of commercial insurance and wither into no insurance or Medicaid which pays way less.


Walk me thru the optimism..

I’ve only spoken in this forum in regards to what we’re facing with this pandemic. Im saying that big dip and pay and hiring we are seeing is a microcosm of what almost every profession is going through. I’m not talking about medicine as a whole or EM 10-20 years from now. Maybe the outlook for EM 10 years from now is bleak. There are countless other threads talking about the doom of the profession long term. That’s not my angle. But for those who can’t get jobs today bc corona just hit, i’m saying it’ll get better in the short term. It’s an opinion. I’m not Miss Cleo, nor are You.

i’ve always said my optimism is based on my limited scope which is 4 different hospitals. I’m seeing that we cut hella shifts and hours and had barely any patients, but now volume is climbing and we’re adding shifts back. This is a good thing. I think this trend will continue and that in the fall/winter we will be a bit more normal.

 

[Modstopizdy]

Woe is you.

I came from nothing too dude. First generation college. Worked my ass off.

You have a hard time understanding that working hard doesn’t make you special. And nobody owes you ****. What does make someone special is having empathy for others and making the best out of the twists and turns life gives us.

I hope things get better. And I think they will. I stand by that. If you don’t like that outlook, you can continue to pontificate about the life of someone on the internet you’ve never met. Have at it.

I remember being down and out looking at these message boards, and positivity and encouragement here helped me. So this message goes to the residents and med students. You have a dynamic and lucrative job a head of you. I’m still positive about EM and enjoy what i do in spite of my loans and a 40% pay cut today. This pandemic hurts us, but I’m seeing improvement day by day and I think we are going to bounce back. Keep keeping on, guys.

You have a hard time with logic it seems. Your original claim was that unemployed graduating residents should feel fortunate compared to unemployed fast food workers. Now that this ludicrous claim has been destroyed by multiple people, you're off making weird assertions about the moral value of hard work and how working hard doesn't make anyone special. That's great bud, but neither I nor anyone else made claims that hard work makes us special, it's a strawman you both created and destroyed within the confines of one sentence in your own post. Anyway, I'm out of this conversation because it's clear you're not debating in good faith.

 

[Emerbeamer]

You have a hard time with logic it seems. Your original claim was that unemployed graduating residents should feel fortunate compared to unemployed fast food workers. Now that this ludicrous claim has been destroyed by multiple people, you're off making weird assertions about the moral value of hard work and how working hard doesn't make anyone special. That's great bud, but neither I nor anyone else made claims that hard work makes us special, it's a strawman you both created and destroyed within the confines of one sentence in your own post. Anyway, I'm out of this conversation because it's clear you're not debating in good faith.

Nah. It’s clear that you’re miserable. When you acted like you’re exceptional for working hard and getting debt like countless other physicians including myself. Get over yourself. No one cares. I don’t. Your patients won’t. But they will care that you hop off that pedestal you’re on that makes you think your struggles are superior to theirs or that somehow you deserve immunity from the bull**** nearly everyone is facing in this pandemic or faces in life in general. Goodbye.

 

[Modstopizdy]

It’s difficult to argue with your moral narcissism, so I don’t really know what anyone else can say to you at this point.

That dude is projecting so hard it's comical to watch. While everyone else is just talking numbers and trends, he's off in his own world throwing down thunderbolts of moral-bloviation at us, then hilariously accusing us of acting high and mighty lmao. You can't make up that kind of lack of self awareness if you tried lol.

 

[Emerbeamer]

I find that people who bury their heads in the sand tend to do so out of fear, and this is probably no exception. While optimism can be an excellent trait, optimism against all evidence tends to occur when someone is so terrified of what is really happening that they will tell themselves whatever happy thing they need in order to avoid facing reality. So in this case “we’re all lucky, and everything will get back to normal soon”.

For myself, I’m by no means all doom and gloom. I know I’m not going to starve and I know EM isn’t suddenly disappear. But I’d rather acknowledge that the career I thought I was going to have and the money I was going to make probably isn’t going to happen, and embrace that reality, and adjust to it. Rather than pretending that what I thought this would be is going to just magically fall into place.

I find the people who are constantly pessimistic are that way because they have an inability to cope with disappointment and failure. Rather than thinking positively about a situation that may end up not working out favorably, they project pessimism and negativity to buffer a potential blow. The worst offenders can’t even stomach optimism as an opinion, and project their pessimism as though they have the ability to predict the future precisely. The worst pessimists don’t even want optimists be optimistic bc ..why should anyone think positively if they don’t. They know best, after all.

If two months ago I was making the money and enjoying the career that I thought I would have, and a pandemic hits, I’m going to make a logical assumption that things could get better when said once in a lifetime pandemic ends. And the great thing about my point of view is, I don’t have to be right. Nor does the pessimist. We all take on different worldviews that shape how we live our lives

 

[sloh]

That dude is projecting so hard it's comical to watch. While everyone else is just talking numbers and trends, he's off in his own world throwing down thunderbolts of moral-bloviation at us, then hilariously accusing us of acting high and mighty lmao. You can't make up that kind of lack of self awareness if you tried lol.

Thunderbolts of moral-bloviation stealing!


Sent from my iPhone using Tapatalk

 

[Emerbeamer]

That dude is projecting so hard it's comical to watch. While everyone else is just talking numbers and trends, he's off in his own world throwing down thunderbolts of moral-bloviation at us, then hilariously accusing us of acting high and mighty lmao. You can't make up that kind of lack of self awareness if you tried lol.

Lol. I knew you’d be back. and now “everyone else” is involved you say , making you feel less dumb for acting like having loans and working hard made you special on an EM doc forum.

 

[Porfirio]

Hope for the best, prepare for the worst. New grads should go anywhere, make as much money as you can, and continue to live like a resident. This will set you for life in less time than it took all of medical school. Do it for all of the time of medical school and residency, and you can be done with medicine for good.

 

[wamcp]

Hope for the best, prepare for the worst. New grads should go anywhere, make as much money as you can, and continue to live like a resident. This will set you for life in less time than it took all of medical school. Do it for all of the time of medical school and residency, and you can be done with medicine for good.

Get out quick and make what you can ASAP.

what is worse than COVID and also accelerated by the pandemic is the growing public demands for a public option followed by single payer system.

Single payer is the biggest threat to current income and lifestyle.

Examples. Taiwan and South Korea are single payer.

In Korea the average salary is 126K.
in Taiwan it is 116K at the HIGHER END of the scale.

in both countries, the attendings are worked HARDER than in the US. They both have THREE TIMES the number of consultations/visits than the OECD average.

How would you feel getting paid less than half of what you make today, but have three times the workload? (Taiwan’s ER crisis Taiwan’s ER Crisis｜Politics & Society｜2017-08-25｜CommonWealth Magazine)

oh and don’t forget about single payer canada, where if you want to practice, you have a 20% chance of being unemployed. Nearly one in five new specialist doctors can’t find a job after certification, survey shows

Health Care for All: The Good & Not-So-Great of Taiwan's Universal Coverage - The News Lens International Edition

Taiwan’s health care system is often measured against the world’s best. But is this model of accessible and ‘cheap’ health care viable in the long run?

international.thenewslens.com

Doctors' Average Monthly Wage 13M Won, 4.6 Times Full-Time Laborer - Be Korea-savvy

A study conducted by the Ministry of Health and Welfare has found that the average monthly wage of South Korean physicians was 13.04 million won in 2016, an amount 4.6 times and 8.7 times higher than the average monthly salaries of full-time employees (2.79 million won) and non-regular workers...

koreabizwire.com

 

[BoardEligibleEventually]

Some of them yes. You could secure a job over others especially at academic centers by having completed one (if hiring). You are buying time for a year with a somewhat paid position with benefits, during a hiring freeze that might leave you jobless otherwise.

Toxicology could "maybe" give you something to fall back on with a poison control center
EMS can give you an edge and extra pay if you become an EMS medical director for a facility that needs one
Critical care does not lead to extra pay
US does not lead to extra pay unless you are lucky to land a US director position
Wilderness, Simulation, Informatics, administration, health policy will probably be worthless unless it really interests you
Addition/Pain management/ Palliative will always likely have jobs available these days
Peds EM- Less pay

Despite not increasing pay, I suspect that fellowships may give someone an edge in the job hunt where a candidate contending for the same position is not fellowship-trained - academic gig, or otherwise. This 1-2 years of additional experience in general and confers some more expertise. A survey of department chairs rated additional skills from fellowship training in a potential hire, ultrasound being #1 and critical care #2.

 

[miacomet]

Haven't posted here in years but been lurking through the years. It is bad right now. Even in the midwest it ain't that great. A big academic center cut pay 25% for the year. Another one is cutting up to 50%. It is easy to google them and you will see. PEM departments have been furloughed for the year. Midlevels gone from the last place I worked. Not furloughed but shifts cut forever. Things are changing and I am not seeing the silver lining. Even locums is starting to dry up compared to 2-3 years ago. Things are changing in EM and it is not a bad idea to let residents know. This is the same forum that I use to follow years ago when rates were 400+ and there was a ton of optimism here. I don't remember it always being the doom and gloom.

I have gone for the hospital employed model because I am tired of being sold out to Envision, USACS, Vituity, TH, Alteon, APP. I have worked for almost all of them now. Hospital has invested a ton of money into my loan repayment so I doubt they will sell out to TH tomorrow. I don't know how we change this. More physicians as CEOs of hospitals? How do we even get there? I wish we would come up with a strategy to go into leadership and execute from the top down. Without going into leadership or law making we are hosed.

Furloughed for the year? Did they close the peds ED?

 

[deleted109597]

Can we keep it civil in here people?

 

[emergentmd]

Way to derail the thread guys. Great Job.

Lets pull it back to be informative. Pay cut, Hours Cut, Midlevel Cut, CMGs going bankrupt, hospitals losing money. The list goes on. It sucks and every hospital based practice have taken the same hit and have the same issues. The office based practices have been decimated much more and some to the point of essentially shutting down.

Practice of medicine has changed for all fields and have been made worse by Covid. EM is no different. We have it worse than some specialites but we have it better also. I would say EM has it better b/c ERs are still opened.

I work mostly in the our physician owned FSERs now and volume has been hit. It is slowly coming back but still took a hit. FSERs will close down because of this as there have been many headwinds before Covid. The saving grace for us is we have control over our practice and expenses.

I have been practicing for 20 yrs so I have made my $$$ and have a good amount saved. I shudder to think what would happen if I had to look for a hospital based job with a mountain of debt.

It is sad to see how much EM has changed. 3 yrs ago I had 40-60 shifts a month offered at $275-325/hr with bonuses attached, all in a top 10 populated city. I used to discuss with my locums group that I would never do a shift at rate. Now you can't find a shift at these rates and most docs would work these places for $225/hr

 

[TheComebacKid]

CMGs going bankrupt

Wait, what part of this is bad again?

In all seriousness, I highly doubt CMGs will be going bankrupt. If anything, I think this crisis will show them how much they skim off the top at the expense of their physicians, and continue to drive salaries down going forward.

They are taking a temporary blow, no question, but I suspect that will never stay down for the count and will come back more profitable than ever.

I think the economy will rebound. Patient volumes are already rebounding. Jobs will rebound. Will salaries and hourly wages? That's what I'm more concerned about.

Also, the issue of supply/demand of physicians is always brought up. Within EM, the huge spike in applicants over the years is undoubtedly due to these high hourly wages and promise of good work/life balance. Isn't it possible, that EM in the next 10-20 years will become so unappealing a specialty to work in, that the pendulum will swing the other way and we will go back towards having a shortage?

 

[emergentmd]

Wait, what part of this is bad again?

I am not saying that going Emcare going bankrupt is bad, but sometimes the new contract holder will screw you more. Also, if Emcare goes bankrupt, all they will do is negotiate down debt and lower the Doc's rate.

 

[HemorrhagicShock]

Also, the issue of supply/demand of physicians is always brought up. Within EM, the huge spike in applicants over the years is undoubtedly due to these high hourly wages and promise of good work/life balance. Isn't it possible, that EM in the next 10-20 years will become so unappealing a specialty to work in, that the pendulum will swing the other way and we will go back towards having a shortage?

The numbers simply do not imply there will be a shortage. It's just not possible on the 10-15 year time frame.

God bless those poor EM-bound medical students who are currently gearing up for a surprisingly competitive COVID19-laden interview season. They have about 4-5 years before they're ready to hit the ground running as attendings. Multiply this by the fact that every year HUNDREDS of new EM residency positions are opening (short term revenue gain for chain hospitals - it's a common misconception that CMGs "open" the residencies. Don't get me wrong, CMGs are 100% complicit in this too, as they'll support and work in tandem with the hospitals to achieve this goal. It helps both of their bottomlines, and eventually provides a steady stream of local new blood to keep departments staffed and hourly rates low. The oversupply of EM-trained physicians is real and already here. Compound this with an oppressive amount of debt slavery, which requires in some cases 5-10 years to pay off reasonably with a full time job (yes lots of variables here but not germane to the overall theme of my point). Add in the final death blow of cheap midlevel coverage, and a steady/growing supply on their end (midlevel "residencies" and "fellowships..." barf), and the recipe is complete. If you want to put some icing on this cake, consider that there's very few fellowship options for EM that take you out of the ED into a different practice environment, or even guarantee you a niche that will be revenue positive (this topic was covered above by other posters)

Take all of that above, and it's astoundingly easy to see that even on a 10-15 year time frame there will be no "shortage." The numbers paint an obvious picture barring some omnibus legislative package, and really at this point the only thing that could shake things up substantially is single payer (and god help us if that becomes a reality, thankfully the insurance lobby, pharmaceutical lobby, and cultural zeitgeist are far too powerful for this to ever be a concern. That's the first time I've ever thanked those lobbies).

And let's entertain the idea of a shortage for a second. Just for fun.

A shortage doesn't necessarily imply wages will increase. Surprise billing and predatory payor networks will do everything they can to deny any kind of emergency payment, or reimburse at what is effectively a loss to the physician group and the hospital. EMTALA (which I agree with in spirit) will always remain an unfunded mandate that will continue to be weaponized against us. Patient satisfaction and lack of tort reform will allow for continued hemorrhaging via defensive medicine and absurd malpractice premiums. Oh yea, add in a sprinkle of pathetic medicaid "reimbursement" too. Remember, departments are staffed (in some areas) almost fully by midlevels, with a near steady stream of PAs/NPs all wanting a piece of the pie. What does this mean for you as an ER doc in a hypothetical world with a "shortage?" - it means business as usual since hospitals only need your "expertise" for advertising, deflecting risk onto your license, and that relatively rare tough or complicated case.

When I go down this argument hole with some of my "recklessly optimistic" colleagues they like to bring up the example of Anesthesia:

"Well they have CRNAs and they're doing just fine"

The two couldn't be more different. Our Anesthesiology ("MDA" haha!) are still making nice salaries ($400k/year and above) because they can suckle on the teat of outpatient elective procedures. They can own ASCs (comparing those to urgent cares is a non-starter in terms of revenue). Their fellowship opportunities are very lucrative and add quite a bit of revenue-positive expertise (pain, transplant, cardiac, CCM, etc.) They can choose to not practice in EMTALA-bound environments. Their schedules allow for a longer career, where acuity and complexity can be mitigated if desired.

My hypotheses for what 10-15 years from now may look like:
- The incoming medical students into low- and mid-tier EM residencies will be IMG/Caribbean graduates (look to nephrology and FM as examples, and even low-tier IM/hospitalist medicine)
- In many mid-sized EDs there may only be 3-4 MD/DOs (one director, perhaps 2-3 others doing other administrative/quality/committee/leadership work) all responsible for a team of 10-12 midlevels who do all the bedside clinical work. These docs rotate "call" and are available for consult on difficult cases
- Maybe some of these hospital chain/CMG residencies will lose steam, a few will close, and opening more may no longer be a smart revenue-positive business strategy
- ACEP continues to be tone deaf, AAEM continues to be anemic, the AMA continues to be a detriment to our overall profession
- Midlevels will have full independence, unclear in my mind how medmal will work in this situation, but I suspect they'll be individually liable (as CRNAs are in many states). This may be one of our only saving graces, though I'm not hopeful for a variety of reasons.
- Practice environment will become more risky as fewer specialists want to deal with call knowing they can make good money staying away from the hospital/EMTALA politics
- Entrenched two-tiered system, where if you are in the lower class, you simply do not get a choice of wanting to see the doc. You get Karen NP or Chad PA-C or you can leave. If you are in the upper class, then you likely can afford access to MD/DOs for your emergent needs (we are already at this point in some areas and for certain low-SES patients)

Okay this rant is way too long. The only people who really need to read the above stream of consciousness are medical students - you all can still be saved. Otherwise I'm just preaching to the choir!

 

[TheComebacKid]

All very fair points... but it doesn't address one thing. Your comments, as well as others in this thread, are being read by rising third and fourth year medical students who are feverishly trying to decide what specialty to go into. The overall poor state of our specialty, and poor projected state of our specialty over the next several years (potentially decades), is sinking in. All of a sudden, other specialties are becoming more appealing. The supply from the medical school standpoint, I suspect, will likely cool off. If you look at the boom in the number of applicants to residency, I think it was very much reflective of the comments in this forum over the past several years i.e. 500/hr wages, good locums opportunities, etc. Now that those have dissipated, I wonder if the rate of growth of new physicians will slow down. I reckon that it will still be a long while before we have a true shortage per se, given we still have a lot of hungry docs who want to make some coin.

I also really, really want everyone in this forum to hone in on a key point in the above post... that being regarding ACEP. If you want ACEP to do something, now is the time to stop paying them dues. I agree they are in bed with the CMGs, but now more than ever is the time to divert your funds (if you are lucky to have any) to AAEM.

 

[suckstobeme]

All very fair points... but it doesn't address one thing. Your comments, as well as others in this thread, are being read by rising third and fourth year medical students who are feverishly trying to decide what specialty to go into. The overall poor state of our specialty, and poor projected state of our specialty over the next several years (potentially decades), is sinking in. All of a sudden, other specialties are becoming more appealing. The supply from the medical school standpoint, I suspect, will likely cool off. If you look at the boom in the number of applicants to residency, I think it was very much reflective of the comments in this forum over the past several years i.e. 500/hr wages, good locums opportunities, etc. Now that those have dissipated, I wonder if the rate of growth of new physicians will slow down. I reckon that it will still be a long while before we have a true shortage per se, given we still have a lot of hungry docs who want to make some coin.

I also really, really want everyone in this forum to hone in on a key point in the above post... that being regarding ACEP. If you want ACEP to do something, now is the time to stop paying them dues. I agree they are in bed with the CMGs, but now more than ever is the time to divert your funds (if you are lucky to have any) to AAEM.

I dunno, man. I think if there are programs with spots, they will fill; they will just be less selective in who they take. These CMGs aren't going through the hoops of setting these faux residencies up just to see them go unfilled.

I don't see anyway out of this. Is there any organization that can limit the proliferation of these programs? ABEM, RRC, ACGME? is the fact that we are likely oversupplied with ED docs grounds to prevent new programs from opening?

 

[alpinism]

If med students get anything out of this thread it should be that out in the real world most hospitals don’t respect emergency physicians and will hire whoever is the cheapest. That means not only will you be competing with other EM residency grads but also non EM residency grads who are usually willing to work for half the hourly pay.

For example UCSF family physicians staff multiple bay area ERs including Contra Costa Regional Hospital which sees over 60K patients.

Family Medicine Residency Faculty :: Contra Costa Regional Medical Center :: Contra Costa Health

Contra Costa Family Practice Residency Program.

cchealth.org

 

[Groove]

If med students get anything out of this thread it should be that out in the real world most hospitals don’t respect emergency physicians and will hire whoever is the cheapest. That means not only will you be competing with other EM residency grads but also non EM residency grads who are usually willing to work for half the hourly pay.

For example UCSF family physicians staff multiple bay area ERs including Contra Costa Regional Hospital which sees over 60K patients.

Family Medicine Residency Faculty :: Contra Costa Regional Medical Center :: Contra Costa Health

Contra Costa Family Practice Residency Program.

cchealth.org

Yep, the cold, harsh reality is that FM/IM with experience make for great EM docs. This is coming from an ABEM doc. Yes, I can notice an immediate higher quality in competence when comparing a fresh RRC EM graduate versus someone FM with a year EM fellowship but once the FM guy is seasoned, it's really not noticeable at all to me. Most of the EDs in my city don't have an ABEM only bylaw except for the academic ED where our residency program is located. I suppose if it's in a high demand location then the FM guys might not have access to certain EDs, but let's face it, the majority of EDs in the country don't require ABEM.

I think this is an example of why we get such little respect from other specialties in the hospital. I mean, where do you see an IM guy doing an appendectomy or an FM guy doing endoscopies and colonoscopies? How about FM doing heart caths? People know we're a melting pot of different specialties and view us as nothing more than triage doctors. And you know what? Some days I DO feel like a triage doctor... Hell, I've worked with general surgeons, IM, FM, 1 ENT doc and two cardiologists, all who were FT or PT emergency docs. What does that say about the specialty? The ENT doc (FT) and the cardiologist (one PT and the other FT) blew my mind...and all of them were great EPs!

 

[deleted941485]

Yep, the cold, harsh reality is that FM/IM with experience make for great EM docs. This is coming from an ABEM doc. Yes, I can notice an immediate higher quality in competence when comparing a fresh RRC EM graduate versus someone FM with a year EM fellowship but once the FM guy is seasoned, it's really not noticeable at all to me. Most of the EDs in my city don't have an ABEM only bylaw except for the academic ED where our residency program is located. I suppose if it's in a high demand location then the FM guys might not have access to certain EDs, but let's face it, the majority of EDs in the country don't require ABEM.

I think this is an example of why we get such little respect from other specialties in the hospital. I mean, where do you see an IM guy doing an appendectomy or an FM guy doing endoscopies and colonoscopies? How about FM doing heart caths? People know we're a melting pot of different specialties and view us as nothing more than triage doctors. And you know what? Some days I DO feel like a triage doctor... Hell, I've worked with general surgeons, IM, FM, 1 ENT doc and two cardiologists, all who were FT or PT emergency docs. What does that say about the specialty? The ENT doc (FT) and the cardiologist (one PT and the other FT) blew my mind...and all of them were great EPs!

From what I gather that’s what it was like way back when. Before EM became its own thing. You had a rotating crew of docs from the area service the ED surgeons, GPs, specialists, moonlighting residents what have you. It’s how newbies built practices and probably how they stayed well rounded clinically.

Today everything gets more and more compartmentalized and turf lines are drawn. Lots of reasons for that.

 

[Groove]

From what I gather that’s what it was like way back when. Before EM became its own thing. You had a rotating crew of docs from the area service the ED surgeons, GPs, specialists, moonlighting residents what have you. It’s how newbies built practices and probably how they stayed well rounded clinically.

Today everything gets more and more compartmentalized and turf lines are drawn. Lots of reasons for that.

Yeah, the irony is that back then my dad can remember working in the ED as an intern. You basically triaged and stabilized and called for help at the first available opportunity where the specialist kind of took over, at least according to him. So, we develop this specialty where we want to "bring skills the specialist possesses and put them in the hands of the ED docs" who are now more specialized and have a more varied skillset. I.E. Don't need to call the surgeon for chest tubes, don't need to call anesthesia for intubations, don't need to call cards to cardiovert, etc.. The thought was to bring critical care medicine and initiate it early in the ED because that's what was best for the pt.

Now what do we have today? CMG/hospitals/c-suite obsession with TATS, LWOTS, AMAs, LOS, etc.. EPs brow beat to discharge and/or admit as fast as they can. Faster, faster! (whip cracking on our backs) No more bringing critical care medicine to the ED, it's almost as if we've reversed thought and are now going backwards or full circle around to our starting point. But hey, it was a nice 48 year experiment...

 

[Groove]

I'm kind of exaggerating, but...not really.