EM hourly pay/salary??

[chessknt]

Are these rates subsidized or is it normal in em to be able to bill 10 wrvu per hour?

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[e30ftw]

Just make sure you do some soul searching before signing up for single-coverage 12 hr shifts in a 30k+ volume ED. That volume stat may have been based on 3 years ago and they may be seeing 36k/yr by now, etc..

You never know.

In either case, 30k/yr single coverage with a single mid-level shift is quite busy and you should be well compensated. Day shifts are going to be pretty miserable having 15 patients sign in every day at 4pm after you've been there for 9 hours and have already seen 30 patients. 82/day, probably 60 of those are going to come in between 7a-7p. Night shift might not be too bad but count on coming into a disaster almost every shift at 7p and having to spend 5-6 hours clearing it out.

Not that we all don't deal with this anyway but it's much more sustainable working 8 and 10s with overlap..

Just saying. It's doable but I would not work 12s single coverage in anything more than about 20k if only 1 PA shift.

 

[BoardingDoc]

Are these rates subsidized or is it normal in em to be able to bill 10 wrvu per hour?

???
10 RVU should be paying out around 400-500 bucks. Unless you're asking if you're subsidizing the hospital/group.

 

[chessknt]

???
10 RVU should be paying out around 400-500 bucks. Unless you're asking if you're subsidizing the hospital/group.

I'm assuming it would be unusual to get rates that high with an average payor mix. I'm just using cms rate as a gauge. What is the normal hourly rvu based on pph?

 

[BoardingDoc]

I'm assuming it would be unusual to get rates that high with an average payor mix. I'm just using cms rate as a gauge. What is the normal hourly rvu based on pph?

The national average $/RVU in EM is anywhere between 40-50. I don't know what you're using as your data for medicare reimbursement (which is certainly lower than private insurance) but you're not treating solely medicare patients in the ED.

 

[chessknt]

The national average $/RVU in EM is anywhere between 40-50. I don't know what you're using as your data for medicare reimbursement (which is certainly lower than private insurance) but you're not treating solely medicare patients in the ED.

What about uninsured patients or medicaid? Is that accounted for in that figure?

 

[Frazier]

But yeah he didn't make an offer. So he's probably hoping I say $200 an hour. What's a good amount that won't end the conversation right away but still gives me some power lol? It's really one of my 3 options.

350-400.

Now you have the full spectrum from med student to attending saying those numbers. Like it was said earlier, they will counter so absolutely start high. You bring a lot to the table, show them your confidence.

Think of all the second guessing you'll have if the conversation takes place like this:

Job: so what figure do you have in mind?
You: I thought it over... $300/hr.
Job: Really? DONE! see you Monday.
You:

 

[shoal007]

this is a really busy practice. 2 docs, 1 app? crazy. we have similar volume and have 45 hrs of doc coverage. (2x as much as you) and some days can be very busy.

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[GTP]

Just make sure you do some soul searching before signing up for single-coverage 12 hr shifts in a 30k+ volume ED. That volume stat may have been based on 3 years ago and they may be seeing 36k/yr by now, etc..

You never know.

In either case, 30k/yr single coverage with a single mid-level shift is quite busy and you should be well compensated. Day shifts are going to be pretty miserable having 15 patients sign in every day at 4pm after you've been there for 9 hours and have already seen 30 patients. 82/day, probably 60 of those are going to come in between 7a-7p. Night shift might not be too bad but count on coming into a disaster almost every shift at 7p and having to spend 5-6 hours clearing it out.

Not that we all don't deal with this anyway but it's much more sustainable working 8 and 10s with overlap..

Just saying. It's doable but I would not work 12s single coverage in anything more than about 20k if only 1 PA shift.

Yeah this is good advice. The area is so limited. There's another shop nearby offering $200 per hour for 45k volume. I think it's two docs during the day and still one doc at night. I think it's two mid levels one up front and one in the back but the latest one is still at 1 am. This seems like a worse gig than the first one.

 

[emergentmd]

But yeah he didn't make an offer. So he's probably hoping I say $200 an hour. What's a good amount that won't end the conversation right away but still gives me some power lol? It's really one of my 3 options.

For a job to ask you to make an offer without first giving you an offer is strange. It almost seems they do this so some sucker who thinks 150/hr is a great deal of money and then overshoot this by requesting 200/hr.

Obviously this place is difficult to attract good docs, otherwise, they would not tell you to give them an offer.

IMO, shoot high. They don't really have that many options. Go 300+/hr with Benefits.

 

[emergentmd]

Yeah this is good advice. The area is so limited. There's another shop nearby offering $200 per hour for 45k volume. I think it's two docs during the day and still one doc at night. I think it's two mid levels one up front and one in the back but the latest one is still at 1 am. This seems like a worse gig than the first one.

45k=120 pt/dy. 36 hr doc coverage. Seems like poor MD coverage IMO. Hope the Midlevels are top notch.

Many places I work, the Midlevel up front does very little other than clicking the greet times, order a bunch of crappy tests. They really don't see much.

 

[Boatswain2PA]

I can ask a mid level I met 30 seconds ago how much they make per hour ? I must be the only one who gets nervous talking/asking about money.

I was suggesting bringing up the topic of midlevels at your follow up interview. Quality, supervision, scope of practice, turnover, pay, etc. All that could give you an idea of whether they take the snot clinic or they help with the sick patients.

 

[BoardingDoc]

For a job to ask you to make an offer without first giving you an offer is strange. It almost seems they do this so some sucker who thinks 150/hr is a great deal of money and then overshoot this by requesting 200/hr.

Obviously this place is difficult to attract good docs, otherwise, they would not tell you to give them an offer.

Disagree on this one. This is standard business practice in many fields outside of medicine and I have seen this firsthand from a few highly desirable shops during my interview process. Your rationale about their motives is of course sound, as the entire purpose of this in every industry is to get you to low-ball yourself. Always ask for more than you think they are willing to pay you.

 

[GTP]

Thanks you guys. You have given me a lot to consider. My goal is $400 and maybe we will settle on 350. It sounds like I'll really work to earn that money with the way this shop is set up.

 

[bravotwozero]

Thanks you guys. You have given me a lot to consider. My goal is $400 and maybe we will settle on 350. It sounds like I'll really work to earn that money with the way this shop is set up.

You should make that argument when you're negotiating to give yourself leverage - this shop is pretty brutal with its coverage and I'd expect to be well compensated to work here.


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[Groove]

30K single coverage ED with a single MLP? No way dude. Count me out. Have fun signing those MLP charts on the level 2's you were too busy to see and the MLP with one year XP had to pick up.

 

[GTP]

30K single coverage ED with a single MLP? No way dude. Count me out. Have fun signing those MLP charts on the level 2's you were too busy to see and the MLP with one year XP had to pick up.

There is a mid level till 1 am. I'm not excited but my options are limited. The other thought is to drive an hour away to make $150-180 an hour and factor in staying in a hotel on the days that the snow is too brutal to drive through after a 12 hour shift.

 

[GTP]

You should make that argument when you're negotiating to give yourself leverage - this shop is pretty brutal with its coverage and I'd expect to be well compensated to work here.


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What sign on bonus would be reasonable for a place like this ? I don't need a relocation bonus and I don't want some shady loan repayment that will take my soul for 5 years

 

[Groove]

40-50K for 2y. They will probably offer 15-25K which I would promptly turn down. Honestly, I wouldn't even take a sign on in a place like you've described as the chances you would need to punch the emergency bail button are infinitely higher.

As for your options. They are only as limited as you want them to be. It sounds like you are committed to this location regardless of the prospects and that's a personal thing. However, if you have an airport nearby, I'd consider locums. Who knows though, you may like this gig but the whole thing smells bad from where I'm sitting.

 

[GTP]

40-50K for 2y. They will probably offer 15-25K which I would promptly turn down. Honestly, I wouldn't even take a sign on in a place like you've described as the chances you would need to punch the emergency bail button are infinitely higher.

As for your options. They are only as limited as you want them to be. It sounds like you are committed to this location regardless of the prospects and that's a personal thing. However, if you have an airport nearby, I'd consider locums. Who knows though, you may like this gig but the whole thing smells bad from where I'm sitting.

The airport is an hour away. Obviously I wouldn't get on a plane for $200 an hour. So for a locum to make sense I'm thinking at least $250. How ever, won't I run into the same problem ? I don't think the nice shops with amazing techs amazing nurses and amazing consultants with 1-2 patients an hour need locums. And if they needed locums they wouldn't pay good enough coin. I'm just assuming because this hospital we have been talking about uses locums. The other crappy one nearby that I mentioned above with the volume of 45 k and 36 hours of doc coverage also uses locums. If I'm gonna get pooped on regardless I'd rather be able to see my significant other daily and not have to deal with living out of a suitcase

 

[Groove]

Man, it sounds like this is in the middle of nowhere. Just out of curiosity, why are you guys so committed to this one location?

 

[GTP]

Man, it sounds like this is in the middle of nowhere. Just out of curiosity, why are you guys so committed to this one location?

My husband has lived there for 12 years and loves it. I lived there for 2 years and I like it too. We have good trustworthy friends. Housing is dirt cheap. Safe area. Short plane ride to all the places I like to visit but wouldn't live. NYC Chicago, etc It's close to the border and the other half of my life is in Canada

 

[Groove]

My husband has lived there for 12 years and loves it. I lived there for 2 years and I like it too. We have good trustworthy friends. Housing is dirt cheap. Safe area. Short plane ride to all the places I like to visit but wouldn't live. NYC Chicago, etc It's close to the border and the other half of my life is in Canada

Makes sense. Good luck!

 

[GTP]

Don't smack me you guys. Just got home after a few days and reviewed my notes about this shop. Apparently I get a mid level from 8 pm to 6 am. There is another one there from 10 am to 10 pm. So it's 24 h doc and 20 h mid level coverage. Oops!!!. Guess I can't ask for $400 anymore. Lol

 

[tvelocity514]

I was suggesting bringing up the topic of midlevels at your follow up interview. Quality, supervision, scope of practice, turnover, pay, etc. All that could give you an idea of whether they take the snot clinic or they help with the sick patients.

Don't smack me you guys. Just got home after a few days and reviewed my notes about this shop. Apparently I get a mid level from 8 pm to 6 am. There is another one there from 10 am to 10 pm. So it's 24 h doc and 20 h mid level coverage. Oops!!!. Guess I can't ask for $400 anymore. Lol

I think you need to take Boatswains advice - mostly to get an idea of the type of MLP's you will be working with. I also think you should go hang out for a day on one of your days off if possible and really see how they work. If they are really on the ball and doing amazing work, it won't be horrible, but you are still not signing up for easy work regardless.

Also, don't low ball yourself just bc they have one MLP that works a little longer than you thought. A lot of attendings have made good points and given you great advice so far. Have you already told them of your necessity to stay? If not, you have more leverage than you think.


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[deleted547339]

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[GeneralVeers]

Don't smack me you guys. Just got home after a few days and reviewed my notes about this shop. Apparently I get a mid level from 8 pm to 6 am. There is another one there from 10 am to 10 pm. So it's 24 h doc and 20 h mid level coverage. Oops!!!. Guess I can't ask for $400 anymore. Lol

The number of MLPs doesn't affect what you can ask. They require a physician present 24 hours, period. The more desperate they are, the more they will have to pay to get one.

 

[emergentmd]

Seriously, everyone's situation is different.

If its your dream place, $300/hr seems reasonable.

 

[GTP]

Seriously, everyone's situation is different.

If its your dream place, $300/hr seems reasonable.

lol it's not my dream place. My dream place has lots of techs and nurses and all specialities available and easy admits. This seems like I'll need to work really hard. Still mulling it over.

 

[GTP]

I think you need to take Boatswains advice - mostly to get an idea of the type of MLP's you will be working with. I also think you should go hang out for a day on one of your days off if possible and really see how they work. If they are really on the ball and doing amazing work, it won't be horrible, but you are still not signing up for easy work regardless.

Also, don't low ball yourself just bc they have one MLP that works a little longer than you thought. A lot of attendings have made good points and given you great advice so far. Have you already told them of your necessity to stay? If not, you have more leverage than you think.


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Yeah I think I'll go hang out there on a Monday or Tuesday night from 9 pm to maybe midnight

 

[Restart13]

Can anyone speak to the job market/compensation in Michigan at all?

 

[The White Coat Investor]

Seriously, everyone's situation is different.

If its your dream place, $300/hr seems reasonable.

Give me a break. $300 an hour is still a great EM hourly rate despite the handful of people on SDN saying they don't work for less than $400 an hour and they won't tell you where in Texas they're working. I mean, I wouldn't take $300 for a crap job I hated, but for a run of the mill some great things some bad things EM job, it's a nice rate. Plenty of places paying significantly less.

For anyone who wants to argue with me, let's just take a quick look at the data (not the plural of anecdote):

The 2015 Daniel Sterns Survey (usually the highest of the salary surveys although not likely as accurate as the MGMA data) shows:

Employees:
50%ile- $175
90%ile- $235

Partners:
50%ile- $215
90%ile- $300

Bottom line, if someone is paying you $300 an hour they're not ripping you off. Doesn't mean you can't make more somewhere else, but it's not "reasonable for your dream place." It would be wonderful in a dream place and contribute to that place being a dream place.

 

[bravotwozero]

Can anyone speak to the job market/compensation in Michigan at all?

Metro Detroit area I've seen IC gigs for $200/hr, less if it's employee with benefits. Once you get out of Detroit and Ann Arbor, you can make considerably more, particularly in the UP, where the going rate is $280+. Also seen good offers for Saginaw and Lansing.


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[deleted109597]

Give me a break. $300 an hour is still a great EM hourly rate despite the handful of people on SDN saying they don't work for less than $400 an hour and they won't tell you where in Texas they're working. I mean, I wouldn't take $300 for a crap job I hated, but for a run of the mill some great things some bad things EM job, it's a nice rate. Plenty of places paying significantly less.

I agree that $300 is a decent rate, but I'm still not telling you where I'm working.
Why won't I tell? The anonymity goes away completely. The shops I work at aren't in Houston where there are 400 other hospitals. Also, if I ran into you in person James, I'd have no problem telling you. I'm just not going to tell untold people here because 1) the shop will instantly shut it down if they hear about it online, and 2) supply and demand. I didn't get where I am asking people where to work.
There's plenty of CMG clock in/clock out jobs here that are around $300, but they aren't fully staffed. You just have to ask for the money. They can choose to pay it or not.
Tons of places pay less, I agree. But people continue to agree to live/work there for less money. Some of those jobs are absolutely horrible (Clinton, MD comes to mind).

 

[emergentmd]

Give me a break. $300 an hour is still a great EM hourly rate despite the handful of people on SDN saying they don't work for less than $400 an hour and they won't tell you where in Texas they're working. I mean, I wouldn't take $300 for a crap job I hated, but for a run of the mill some great things some bad things EM job, it's a nice rate. Plenty of places paying significantly less.

For anyone who wants to argue with me, let's just take a quick look at the data (not the plural of anecdote):

The 2015 Daniel Sterns Survey (usually the highest of the salary surveys although not likely as accurate as the MGMA data) shows:

Employees:
50%ile- $175
90%ile- $235

Partners:
50%ile- $215
90%ile- $300

Bottom line, if someone is paying you $300 an hour they're not ripping you off. Doesn't mean you can't make more somewhere else, but it's not "reasonable for your dream place." It would be wonderful in a dream place and contribute to that place being a dream place.

Did you not read the job where volume is 36K = 100/dy with single MD coverage for 12 hrs and a ML float that ends around Midnight? He will have days when the ML will suck and see 1 pt an hr. He will have days when he will see 60 in a 12 hr shift.

Sorry, but $300 is not enough.

I agree with the above that no one should give specific about pay. I like to be able to cherry pick shifts and keep the hospitals short. If it gets out, everyone will flood the hospital and everyone's pay will plummet.

 

[deleted109597]

Correct. 36K here gets 40-48 hrs of doc coverage, and 12-24 of ML. If they want 2 docs to do the job of 4, then they need to pay twice as much IMO.

 

[Psai]

Did you not read the job where volume is 36K = 100/dy with single MD coverage for 12 hrs and a ML float that ends around Midnight? He will have days when the ML will suck and see 1 pt an hr. He will have days when he will see 60 in a 12 hr shift.

Sorry, but $300 is not enough.

I agree with the above that no one should give specific about pay. I like to be able to cherry pick shifts and keep the hospitals short. If it gets out, everyone will flood the hospital and everyone's pay will plummet.

Holy **** 60? 300 is a freaking bargain for the hospital

 

[GTP]

I actually went to see this site in person recently. I was in the area and I figured free lunch wouldn't hurt. Long story short, I'll be signing with another hospital. Only way I'd work at that other hospital is if they offered $500/hr if someone can't make it for their shift. Even that's a steal for the hospital given the working conditions.

 

[1Sail0r]

Does anyone have any experience with jobs in the NE? For example, in NJ what is the average hourly pay for an EP?

 

[Boatswain2PA]

I actually went to see this site in person recently. I was in the area and I figured free lunch wouldn't hurt. Long story short, I'll be signing with another hospital. Only way I'd work at that other hospital is if they offered $500/hr if someone can't make it for their shift. Even that's a steal for the hospital given the working conditions.

Details on why?

 

[The White Coat Investor]

Did you not read the job where volume is 36K = 100/dy with single MD coverage for 12 hrs and a ML float that ends around Midnight? He will have days when the ML will suck and see 1 pt an hr. He will have days when he will see 60 in a 12 hr shift.

Sorry, but $300 is not enough.

I agree with the above that no one should give specific about pay. I like to be able to cherry pick shifts and keep the hospitals short. If it gets out, everyone will flood the hospital and everyone's pay will plummet.

I agree I'm not seeing 5 patients an hour for $300. But 2? Sure.

 

[da8s0859q]

I've had several shifts where I've seen 3-4 pph with residents/midlevels for not even close to $300/hr, including after benefits and productivity. Apparently there are greener pastures.

 

[coachB]

I've had several shifts where I've seen 3-4 pph with residents/midlevels for not even close to $300/hr, including after benefits and productivity. Apparently there are greener pastures.

You can't really compare seeing patients in a supervisory role with seeing them on your own. It's completely different work.

 

[da8s0859q]

You can't really compare seeing patients in a supervisory role with seeing them on your own. It's completely different work.

Very true -- except I have a very hard time trusting and not repeating much of what they do, and also, SDN makes "grass is greener" into "grass is greener and with unicorns and rainbows and kegs of your favorite beer and racks of your favorite wine every 100 feet."

 

[GeneralVeers]

Very true -- except I have a very hard time trusting and not repeating much of what they do, and also, SDN makes "grass is greener" into "grass is greener and with unicorns and rainbows and kegs of your favorite beer and racks of your favorite wine every 100 feet."

I don't agree with your statement. Those of us who do locums full time have been pretty up-front with the fact that our jobs are in less desirable areas and may have difficult work environments. Also locums is definitely a hardship for people with young children, or who don't like to be away from home. That is why they pay more. If unicorns and beer were included, the jobs would pay $120/hr like San Diego.

Even at the rate I get, I doubt 90% of SDNers would choose to work where I do given geography, culture, travel, and hospital.

 

[Restart13]

Is it common for fresh grads to pick up 2-3 year contracts in a high income area, pay down a majority if not all of debt, and then take a more desirable, average paying job after? Are there any cons to doing that as far as endangering your ability to go back to an area?

 

[deleted109597]

Are there any cons to doing that as far as endangering your ability to go back to an area?

I hope this myth goes away eventually.
If you are a BC/BE EP you can work pretty much anywhere. Sure, there may be tight markets, but you can still work anywhere. Your job isn't going to care where you came from if you appear stable and don't have red flags sticking up all over your application.
Hell, there are places that even the red flags won't stop them. You probably don't want to work there, but they exist.

 

[emergentmd]

Is it common for fresh grads to pick up 2-3 year contracts in a high income area, pay down a majority if not all of debt, and then take a more desirable, average paying job after? Are there any cons to doing that as far as endangering your ability to go back to an area?

The only thing you will be endangering is your debt.

 

[sum dude]

Give me a break. $300 an hour is still a great EM hourly rate despite the handful of people on SDN saying they don't work for less than $400 an hour and they won't tell you where in Texas they're working. I mean, I wouldn't take $300 for a crap job I hated, but for a run of the mill some great things some bad things EM job, it's a nice rate. Plenty of places paying significantly less.

For anyone who wants to argue with me, let's just take a quick look at the data (not the plural of anecdote):

The 2015 Daniel Sterns Survey (usually the highest of the salary surveys although not likely as accurate as the MGMA data) shows:

Employees:
50%ile- $175
90%ile- $235

Partners:
50%ile- $215
90%ile- $300

Bottom line, if someone is paying you $300 an hour they're not ripping you off. Doesn't mean you can't make more somewhere else, but it's not "reasonable for your dream place." It would be wonderful in a dream place and contribute to that place being a dream place.

Salaries on this site are like step scores (and MCAT scores in the pre-med area). Sure bro, everyone scores 250. $300/hr pffftt, I wouldn't work for less than $350/hr bro, with my 250 Step 1 score and all.

If you are getting paid more than $250-300 an hour anywhere and are not a partner, you are walking into a minefield.

 

[GeneralVeers]

Salaries on this site are like step scores (and MCAT scores in the pre-med area). Sure bro, everyone scores 250. $300/hr pffftt, I wouldn't work for less than $350/hr bro, with my 250 Step 1 score and all.

If you are getting paid more than $250-300 an hour anywhere and are not a partner, you are walking into a minefield.

I had a 208 Step 1 score......But this year I will still gross $600K.