EM hourly pay/salary??

[intubesteak]

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

Great. Thanks to this thread the average step score for EM is gonna jump 4 points from all these overachiever sdn kids who just want to make bank...

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[Jlaw]

Great. Thanks to this thread the average step score for EM is gonna jump 4 points from all these overachiever sdn kids who just want to make bank...

Unless you love it you will burn out in a year making 600k in EM.

 

[GeneralVeers]

Unless you love it you will burn out in a year making 600k in EM.

Really 12 shifts a month burns me out? I work 8 12's, and 4 10's. That is 136 hours/month, which is less than full-time with some CMGs.

 

[Psai]

Really 12 shifts a month burns me out? I work 8 12's, and 4 10's. That is 136 hours/month, which is less than full-time with some CMGs.

I could do this.

 

[GTP]

Details on why?

Single coverage. 3-4 patients an hour crappy emr with limited resources

 

[Hercules]

Really 12 shifts a month burns me out? I work 8 12's, and 4 10's. That is 136 hours/month, which is less than full-time with some CMGs.

Agreed it's not the pay that will burn you out-- it's the hours and the intensity/pain of those hours. I am in a high functioning SDG and get paid very well in a really good work environment. We do 14 shifts a month at 10 8's and 4 10's. That's 120 hrs/mo. It's pretty hard to get burned out working less than 30 hrs/week.


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[The White Coat Investor]

Really 12 shifts a month burns me out? I work 8 12's, and 4 10's. That is 136 hours/month, which is less than full-time with some CMGs.

Just doing some math.....$600K/(136*12) = $367 an hour. Pretty nice average.

 

[deleted109597]

Agreed it's not the pay that will burn you out-- it's the hours and the intensity/pain of those hours. I am in a high functioning SDG and get paid very well in a really good work environment. We do 14 shifts a month at 10 8's and 4 10's. That's 120 hrs/mo. It's pretty hard to get burned out working less than 30 hrs/week.

Depends on the 30 hours. If it involves hitting your head on the wall every shift, then it's absolutely easy to do so. I've been burned out by places I only work 1-2 shifts a month at.

 

[GeneralVeers]

Just doing some math.....$600K/(136*12) = $367 an hour. Pretty nice average.

I figured someone would do math. Yes that is correct, more or less. It took me several years to get to a point where I have several consistent, high-paying jobs that I can tolerate (and that can tolerate me).

 

[Hercules]

Depends on the 30 hours. If it involves hitting your head on the wall every shift, then it's absolutely easy to do so. I've been burned out by places I only work 1-2 shifts a month at.

That's why I said it's the hours AND the intensity/pain of those hours. I totally agree I have worked some places where there is no reasonable price that I work again. Like it would take $1000+/hr to get me back there.


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[RustedFox]

That's why I said it's the hours AND the intensity/pain of those hours. I totally agree I have worked some places where there is no reasonable price that I work again. Like it would take $1000+/hr to get me back there.


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I've said this before on here, but it bears repeating. A buddy of mine told me about how he'd taken a shift at a place just up the road from here for 800/hour.

"Buddy, I'll never do THAT again" was his summary of that shift.

 

[thorg12]

I want to reiterate what rusted fox says.
Some of these people that are seeing 4pts/hr consistently and feel stressed all the time and are getting paid 200/hr are simply getting taken advantage of.
Someone is making a ton of money off your back

 

[NRAI2001]

Bump

 

[miacomet]

Personally, I would not work for less than $200 an hour in the current market. Beyond that, there are a million variables. But I think less than $200 an hour for any kind of volume is just not worth it. Beyond that, volume, acuity, shift schedule, resources, and administration start to matter. But I can't see earning less than that.

 

[emergentmd]

I figured someone would do math. Yes that is correct, more or less. It took me several years to get to a point where I have several consistent, high-paying jobs that I can tolerate (and that can tolerate me).

From your posts, I bet I have worked or work in a very similar practice as you. I may even know you well.

 

[emergentmd]

I've said this before on here, but it bears repeating. A buddy of mine told me about how he'd taken a shift at a place just up the road from here for 800/hour.

"Buddy, I'll never do THAT again" was his summary of that shift.

Personally, I would not work for less than $200 an hour in the current market. Beyond that, there are a million variables. But I think less than $200 an hour for any kind of volume is just not worth it. Beyond that, volume, acuity, shift schedule, resources, and administration start to matter. But I can't see earning less than that.

I would only work at a FSER for less than $200/hr and it has to be a slow one like 1/3 pt an hr Max.

 

[GatorCHOMPions]

New attending out about a year and thought I'd share how it's gone for me.

Job details: Base + RVU, hospital employee at an academic institution with a 401k match, see about 1.7 pph, will probably make about 300k this year having worked about 125 hours per month. I'm just around the golden $200/hour mark, but under the standard 2 pph threshold. Overall I feel pretty good, not too burned out, but admittedly a part of me is envious of everyone talking about their $250+ per hour gigs.

As posters above alluded to, I think a lot of young attendings start out focused on the dollar per hour mark only to wind up in shops where they're in over their head in terms of staffing, volume, acuity, lack of/difficult consultants, etc. A friend of mine is looking for his 3rd job already, I think mostly because he's been chasing the high hourly figures.

 

[EctopicFetus]

New attending out about a year and thought I'd share how it's gone for me.

Job details: Base + RVU, hospital employee at an academic institution with a 401k match, see about 1.7 pph, will probably make about 300k this year having worked about 125 hours per month. I'm just around the golden $200/hour mark, but under the standard 2 pph threshold. Overall I feel pretty good, not too burned out, but admittedly a part of me is envious of everyone talking about their $250+ per hour gigs.

As posters above alluded to, I think a lot of young attendings start out focused on the dollar per hour mark only to wind up in shops where they're in over their head in terms of staffing, volume, acuity, lack of/difficult consultants, etc. A friend of mine is looking for his 3rd job already, I think mostly because he's been chasing the high hourly figures.

Ill say again.. if you work for a CMG and aren’t making $300/hr you are getting taken advantage of.

 

[BoardingDoc]

Ill say again.. if you work for a CMG and aren’t making $300/hr you are getting taken advantage of.

I am in no way defending CMGs, but this statement is absurd. It depends so much on your payor mix, patients per hour, geographic location etc etc. Should you get paid that much assuming you're willing to relocate to an area that maximizes those factors? Sure. If you want to live in a more popular city that has a less desirable payor mix where you don't see a ton of volume, that might be the perfect shop for you, but expecting to get $300/hr in that scenario is unrealistic.

 

[emergentmd]

Ill say again.. if you work for a CMG and aren’t making $300/hr you are getting taken advantage of.

Your Pay like any other economic situation all depends on Supply and Demand.

Even if CMGs are making $500/hr off from your work, you are paid what you are worth in that Area. There is always a paycut associated with working in a sought after city.

Why would Anyone running a business pay someone $300/hr even if they are pulling in $500/hr if there is a well qualified person willing to do that same job for $175/hr?
Just as CMGs may be pulling in $350/hr in a bad payor mix area but paying out $400/hr to staff it b/c Nothing can override the basic tenant of supply and demand UNLESS you are the government who can print money.

 

[EctopicFetus]

I am in no way defending CMGs, but this statement is absurd. It depends so much on your payor mix, patients per hour, geographic location etc etc. Should you get paid that much assuming you're willing to relocate to an area that maximizes those factors? Sure. If you want to live in a more popular city that has a less desirable payor mix where you don't see a ton of volume, that might be the perfect shop for you, but expecting to get $300/hr in that scenario is unrealistic.

You have been fed a lie. People in denver are making $300/hr, same for SoCal, NoCal, Oregon etc.. Does everyone? Of course not.. If you work for cheap for a CMG you are being taken advantage of. I understand everyone has to eat though.. All I am saying is you have to understand the economics of how you are being abused.

 

[EctopicFetus]

Your Pay like any other economic situation all depends on Supply and Demand.

Even if CMGs are making $500/hr off from your work, you are paid what you are worth in that Area. There is always a paycut associated with working in a sought after city.

Why would Anyone running a business pay someone $300/hr even if they are pulling in $500/hr if there is a well qualified person willing to do that same job for $175/hr?
Just as CMGs may be pulling in $350/hr in a bad payor mix area but paying out $400/hr to staff it b/c Nothing can override the basic tenant of supply and demand UNLESS you are the government who can print money.

The paycut only occurs with the CMGs, not democratic groups. All I am saying is you ar working for peanuts you are being taken advantage of. Thats fine you just have to be aware.

 

[EctopicFetus]

Listen I know my opinion isnt popular. We can all sit on here and circle jerk and sing kumbaya. I know some people on here are fine working for CMGs like lemmings. I dont begrudge you. Frankly I dont really care except to know that I hate your employer and what they are doing to medicine and the reputation of EM specifically. If you did a 3 yr em residency and are choosing to flip hamburgers or work for minimum wage flipping burgers I dont care. Im trying to do you guys a favor. Those on here telling you not to work for cheap are doing you a favor. Good times are gonna end soon as residencies proliferate.

 

[emergentmd]

Listen I know my opinion isnt popular. We can all sit on here and circle jerk and sing kumbaya. I know some people on here are fine working for CMGs like lemmings. I dont begrudge you. Frankly I dont really care except to know that I hate your employer and what they are doing to medicine and the reputation of EM specifically. If you did a 3 yr em residency and are choosing to flip hamburgers or work for minimum wage flipping burgers I dont care. Im trying to do you guys a favor. Those on here telling you not to work for cheap are doing you a favor. Good times are gonna end soon as residencies proliferate.

I agree with this and I chose not to work for cheap.

But that doesn't change the fact that the market dictates the income. Many EM docs (lemmings) are willing to work for cheap to stay in a certain area.

 

[GonnaBeADoc2222]

I think it's case by case. I work for a CMG travel team. See about 2-2.2 pph. Somewhat higher acuity. Make between 375-400k for 120-5 hrs/mo. All expenses covered. Guaranteed monthly hours. Almost 100% schedule control. Not bouncing around all the time between facilities (in fact, been at the same one for months). Great nurses. Great co-attendings. Pretty decent consultants. Very supportive medical director.

I think your mileage may vary in this position, and I may have gotten somewhat lucky.

I'd be making more in true locums, but a lot more legwork and not guaranteed hours.

SDG I think is where I'll eventually end up, but my personal circumstances right now makes it somewhat difficult to commit to a partnership track with one.

The schedule control is key for me. That, combined with what I consider to be pretty good, but not ridiculously amazing pay, makes this position work for me right now.

 

[W19]

Why can't IM (hospitalists) make $250+/hr too ?

 

[deleted109597]

Many EM docs (lemmings) are willing to work for cheap to stay in a certain area.

Yes, we all know that we can't fix stupid. That's why we all have jobs to begin with.
The fact that people will live in high COL areas and get paid below average is mind boggling.

 

[deleted109597]

Why can't IM (hospitalists) make $250+/hr too ?

Some do. It's the norm where I live.

 

[W19]

Some do. It's the norm where I live.

I love TX, especially Dallas.

 

[jiffywerk]

What would you guys say is the going rate for working at these smaller (10k and less volume) facilities where your able to do 24hr shifts? I have gotten emails for up to $200/hr for places but after talking to multiple recruiters haven't been able to get it higher then maybe 10-20/hr more then that.

 

[miacomet]

What would you guys say is the going rate for working at these smaller (10k and less volume) facilities where your able to do 24hr shifts? I have gotten emails for up to $200/hr for places but after talking to multiple recruiters haven't been able to get it higher then maybe 10-20/hr more then that.

$200 is the floor IMHO. Many will (and they certainly can) pay more than that. There is a perpetually understaffed VERY rural hospital two hours from me that pays travelers 60% of billing with a floor of $150 an hour. Average is $250-$300 an hour. I've never heard of anyone getting less than $250 at that place. Plus you have a PA that works up the patients after midnight, so you can sleep. I do not work in a well-paying state.

 

[emergentmd]

What would you guys say is the going rate for working at these smaller (10k and less volume) facilities where your able to do 24hr shifts? I have gotten emails for up to $200/hr for places but after talking to multiple recruiters haven't been able to get it higher then maybe 10-20/hr more then that.

10K is about 25/dy. That is tough. I have 24 hr FSER gigs at $190/hr seeing 7/dy. 200/hr for that gig would ROYALLY Suck. Imagine winter time when that volume is regularly 40/dy

 

[miacomet]

10K is about 25/dy. That is tough. I have 24 hr FSER gigs at $190/hr seeing 7/dy. 200/hr for that gig would ROYALLY Suck. Imagine winter time when that volume is regularly 40/dy

Agreed. I have had seasonal volumes of 100 a day in a 10k ER.

 

[emergentmd]

Agreed. I have had seasonal volumes of 100 a day in a 10k ER.

I try to avoid all "slow ERs" in the winter. Slow ERs are single coverage and its a long 12 hrs when you are seeing 3-4/hr

 

[miacomet]

I try to avoid all "slow ERs" in the winter. Slow ERs are single coverage and its a long 12 hrs when you are seeing 3-4/hr

I dunno. The rural ones get crazy in the summer with ag injuries etc. Fear the potato belt...

 

[GeneralVeers]

$250/hr is my floor regardless of volume. My time is valuable, and if I have to sit there, it means I can't be doing something else.

 

[miacomet]

Agreed with Veers.

I would not do locums for less than $250 an hour (and more for nights), no matter the volume unless maybe it's Hawaii and I can write off my trip. Occasionally I have done government for less as the liability is lower and the stress is also less.

Having worked in many smaller ERs, the $h!t can really hit the fan and go south fast. Not fun trying to deal with three or eight traumas when the nearest surgeon is an hour out and everyone has to go by chopper to the nearest trauma center and there's a snowstorm so it's actually a two hour drive.

Even if and when the ER market softens, I doubt I would accept less than that. You can make $150-$250 doing telehealth or UC with lower liability and less stress, so not worth it. You can easily make $100-$150 an hour doing nonclinical with less stress, too. Or I could sit on a beach doing nothing for no money but no stress, either.

Be aware locums companies vary a bunch in what they quote you. I had one company offer me $200 and another $250 for the exact same job last week.

 

[jiffywerk]

Agreed with Veers.

I would not do locums for less than $250 an hour (and more for nights), no matter the volume unless maybe it's Hawaii and I can write off my trip. Occasionally I have done government for less as the liability is lower and the stress is also less.

Having worked in many smaller ERs, the $h!t can really hit the fan and go south fast. Not fun trying to deal with three or eight traumas when the nearest surgeon is an hour out and everyone has to go by chopper to the nearest trauma center and there's a snowstorm so it's actually a two hour drive.

Even if and when the ER market softens, I doubt I would accept less than that. You can make $150-$250 doing telehealth or UC with lower liability and less stress, so not worth it. You can easily make $100-$150 an hour doing nonclinical with less stress, too. Or I could sit on a beach doing nothing for no money but no stress, either.

Be aware locums companies vary a bunch in what they quote you. I had one company offer me $200 and another $250 for the exact same job last week.

I went to the group directly, maybe they have the supply so the demand isn't that much. Interestingly I was able to get a higher rate going through locums and when I brought this up with the group themselves the recruiter told me he could not even match that offer.

For those who have worked locums for a long stretch at a facility, do you ever ask for a raise even if you feel that you are already getting a great rate ($300+/hr) for the quality/pph of work? Say if you have been there over a year? 2 years?

 

[miacomet]

I went to the group directly, maybe they have the supply so the demand isn't that much. Interestingly I was able to get a higher rate going through locums and when I brought this up with the group themselves the recruiter told me he could not even match that offer.

For those who have worked locums for a long stretch at a facility, do you ever ask for a raise even if you feel that you are already getting a great rate ($300+/hr) for the quality/pph of work? Say if you have been there over a year? 2 years?[/QUOTE

Agreed that for some reason hospitals are happy to hemorrhage more via locums companies than directly with docs. Shows the general IQ of hospital admin, right?

 

[miacomet]

I have to share a nutty email I received from a locums company when they offered me the same job for $50 less an hour than a different company. Obviously I brought this to their attention, explaining their offer was far lower than market, and indeed less than UC/telehealth.

"Good morning, thank you for the reply. I understand your concerns. I appreciate that you would like to work with CrappyLocums again. I hesitate to speak for others as I am not sure if they offer all the same level of service and malpractice coverage as CrappyLocums; also we have found that many locums companies advertise high rates and are not always able to deliver or the job only lasts for few shifts after all the work of credentialing. I will always let you know the highest rate the client is suggesting, but in the end I can present you over at any rate you feel is fair. Feel free to give me a call to discuss. Thanks again for the feedback!"

I'm not sure if the administrators would allow me to post the name, but I'd be happy to. The company is a member of a large conglomerate and I've had issues with their other divisions recently. They used to be OK- I think they are, as a burgeoning monopoly, trying to push down locums rates across the board.

 

[Alvarez13]

For those who have worked locums for a long stretch at a facility, do you ever ask for a raise even if you feel that you are already getting a great rate ($300+/hr) for the quality/pph of work? Say if you have been there over a year? 2 years?

I'm approaching a year and I've been wondering the same thing.

 

[emergentmd]

I have to share a nutty email I received from a locums company when they offered me the same job for $50 less an hour than a different company. Obviously I brought this to their attention, explaining their offer was far lower than market, and indeed less than UC/telehealth.

"Good morning, thank you for the reply. I understand your concerns. I appreciate that you would like to work with CrappyLocums again. I hesitate to speak for others as I am not sure if they offer all the same level of service and malpractice coverage as CrappyLocums; also we have found that many locums companies advertise high rates and are not always able to deliver or the job only lasts for few shifts after all the work of credentialing. I will always let you know the highest rate the client is suggesting, but in the end I can present you over at any rate you feel is fair. Feel free to give me a call to discuss. Thanks again for the feedback!"

I'm not sure if the administrators would allow me to post the name, but I'd be happy to. The company is a member of a large conglomerate and I've had issues with their other divisions recently. They used to be OK- I think they are, as a burgeoning monopoly, trying to push down locums rates across the board.

I do my own locums. Had a call from the hospital who wanted me to cover some shifts. Gave me the "rate" everyone was getting.

I told them, why would I want to work there when I am making $50 more here.

Got a call 2 min later and got offered a higher rate.

 

[bky3c]

You can make $150-$250 doing telehealth...

Do you (or anyone else here) have experience with telehealth as an emergency physician? I assume it would be urgent care types of cases, with the ability to tell people "No, you need to go see someone in person" if it's not a ridiculously simple, straightforward issue?

I've been doing locums (only) for years, but it's starting to get old. I don't want a permanent local job for numerous reasons. Taking a pay cut to do telehealth is starting to sound very appealing. Are these $150-250 rates you quoted common? Can anyone recommend a company to contact about working for them?

 

[miacomet]

Do you (or anyone else here) have experience with telehealth as an emergency physician? I assume it would be urgent care types of cases, with the ability to tell people "No, you need to go see someone in person" if it's not a ridiculously simple, straightforward issue?

I've been doing locums (only) for years, but it's starting to get old. I don't want a permanent local job for numerous reasons. Taking a pay cut to do telehealth is starting to sound very appealing. Are these $150-250 rates you quoted common? Can anyone recommend a company to contact about working for them?

I don't think they are common- busy season, multiple state licenses, sign up for weekends and nights, see high volumes etc. Funny, my job is getting old, would like to do locums, but the companies seem to have gone nuts. Any you like?

 

[bky3c]

I don't think they are common- busy season, multiple state licenses, sign up for weekends and nights, see high volumes etc. Funny, my job is getting old, would like to do locums, but the companies seem to have gone nuts. Any you like?

Unfortunately, the companies I've liked in the past do seem to be low-balling, as someone here mentioned, possibly in another thread. The only place with a decent rate lately was one I'll never return to because it was so unsafe.

What about telemedicine jobs with lower rates? I'd be willing to work for significantly less if it didn't mean wasting a day in transit every month and living in a hotel room for 2 weeks at a time. I'm looking at retiring in the next 2 years (yes, very early retirement, assuming I can maintain a reasonable income that much longer), so this wouldn't be a decades-long commitment.

 

[OccupyTheED]

As I scanned this thread and a few similar ones I noticed a few people mentioning "not having guaranteed shifts" when doing locums. If you're dependent on only one site then yes, this can definitely be an issue. But if you hedge your bets with a few local PRN/part time shifts and if you have the flexibility to travel this is almost never an issue, or at least it hasn't been for me. My baseline is 8-10 shifts and if I get bonus or better offers I go up to 20. With as poorly as these companies treat a lot of docs don't be shocked that lots of places are running at less than full capacity and fairly desperate, just my 2 cents. The personal caveat to this is that I'm licensed in 5 states and have no children, so I have personal flexibility that I recognize a lot of others may not.

 

[emergentmd]

As I scanned this thread and a few similar ones I noticed a few people mentioning "not having guaranteed shifts" when doing locums. If you're dependent on only one site then yes, this can definitely be an issue. But if you hedge your bets with a few local PRN/part time shifts and if you have the flexibility to travel this is almost never an issue, or at least it hasn't been for me. My baseline is 8-10 shifts and if I get bonus or better offers I go up to 20. With as poorly as these companies treat a lot of docs don't be shocked that lots of places are running at less than full capacity and fairly desperate, just my 2 cents. The personal caveat to this is that I'm licensed in 5 states and have no children, so I have personal flexibility that I recognize a lot of others may not.

I have 6 places in an hr geographical area. There has not been a month when I was hoping to pick up more shifts. I have about 20 shifts on my desk with bonus attached that I am not picking up.

 

[jiffywerk]

I have 6 places in an hr geographical area. There has not been a month when I was hoping to pick up more shifts. I have about 20 shifts on my desk with bonus attached that I am not picking up.

Do you only work bonus/last minute shifts? I would imagine, as you say you like a large metropolitan area, that places 1-2 hours away from the city would have many people willing to work for less then $400-500/hr.

 

[emergentmd]

My work depends on how desperate sites are. I never commit to any shifts.

When they are desperate, I commit to zero shifts and just pick 6 shifts at 450+/hr
When they start to hire and things get alittle tight, Ill pick up 6 shifts at rate (only weekdays and no overnights)

I do freestandings too and if things get really bad, Ill just do 8 Freestandings and call it a day. Never got to this point.

 

[Angry Birds]

From my experience, this is usually the case. However, I think you can find some rural ER's with low volumes that pay $150/hr, which is a pretty sweet gig, especially if you get sleep at night. Sleeping for dollars.
[/QUOTE

You absolute chump. This is the worst advice ever.