EM is not a lifestyle specialty

[tkim]

I also did UC moonlighting during residency and though it was busy - day after New Year's the NP and I saw 110 patients in 12 hours, it was a very slick setup, making it pretty easy to keep up.

Complaint-driven T-sheets, with electronic d/c instuctions and laser-printed prescriptions kept my writing down to minimum. The MA and RN set up lac / I&D trays when they roomed pts so it was a quick in/out. The XR tech also imaged in advance, with my say so, so I could read films before seeing the pt.

As busy as we were, we always had time to eat a meal while the other person covered.

And during residency, the money seemed like a fortune.

If I ever burnt out of the ER, I'd go to this type of setup in a heartbeat.

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Members don't see this ad.

 

[gman33]

If you never want to work nights, I'd stay away from EM.
Not sure if that's the biggest obstacle for you.
Weekends and holidays, you'll be working them in UC as well.

The lifestyle depends on how much money you want to make.
The numbers vary on your location, but some of the thoughts I had when thinking about lifestyle.

Let's say EM pays around $250k/year for 36 hours a week.
Primary care pays around $180k/year for 50 hours a week.
With those numbers you could make $180/year in EM working 26 hours a week.

If you don't care about money, work half-time in EM, 18 hours a week.
If you do 12's, that's 1 1/2 shifts a week.
Could still pull in around $125k a year.
I bet that's pretty close to what you'd make full-time in EC.

Even if all those shifts were 7PM - 7AM.
I don't think doing that 6 times a month would be too bad.

Sounds a lot better than working 12, 12's in UC.

Sorry if my numbers are a little off, but you get the idea.

 

[residentdoc8]

a

 

[residentdoc8]

edited

 

[deleted109597]

Let's say EM brings in $250K/year for 15-12's/month

Terrible assumption. Number 1, most EM docs aren't working 2160 hours/year. Number 2, those that do aren't doing it for $115 an hour.

UC brings in $180K/year for 15-12's/month-- (i've seen hourly range from $70-100/hr, more on holidays and weekends...so salary can be variable but this estimate is on the lower end)

Still a pretty rough month, even for UC.

Salary difference is large for same amount of hours/shifts worked: $70K-- the trade-off is not working nights (even 6 night shifts a month as you mentioned turns into much more when you factor in the transitional day(s) going back from nights to days like how the rest of the world/your family operates), lower stress level because the work involved is not very challenging although in some places very busy so the time goes by fast, and you have the option of picking up extra shifts to make extra money (of course, at the expense of more work-time). I'm assuming less liability in UC because the cases are not life-threatening (less likely to make mistakes) and long-term care is deferred to the pt's PCP.

Salary differential is wrong for points posted above. UC isn't less liability, it likely ends up being more. You're sued basically at a flat rate for the number of patients you see, so the more you see, the more you're sued. I'm guessing the difference you're seeing is because of the different mentalities between EM and all other specialties that do UC. EM is "what is going to kill this person" followed by everything else. Primary care docs are less concerned about the rare killers, and more about the actual diagnosis. That's why they argue about taking patients that don't have a diagnosis before admission. UC patients might be slightly more likely to be insured, but they're usually not that much more likely to follow up with their PCP for their chronic issues than anyone else.

According to: http://www.alliedphysicians.com/salary-surveys/physicians/ EM and UC docs even out salary-wise in the long run, but not sure how accurate the data is to the real world.

It's not. I will make more in my first year out than that chart says is the max.

 

[TeamZissou]

I also did UC moonlighting during residency and though it was busy - day after New Year's the NP and I saw 110 patients in 12 hours, it was a very slick setup, making it pretty easy to keep up.

Complaint-driven T-sheets, with electronic d/c instuctions and laser-printed prescriptions kept my writing down to minimum. The MA and RN set up lac / I&D trays when they roomed pts so it was a quick in/out. The XR tech also imaged in advance, with my say so, so I could read films before seeing the pt.

As busy as we were, we always had time to eat a meal while the other person covered.

And during residency, the money seemed like a fortune.

If I ever burnt out of the ER, I'd go to this type of setup in a heartbeat.

That's a sick set up. For those residents/attendings- at what point in residency are you typically allowed to moonlight? At what point did you feel comfortable moonlighting? Did the majority do it at UC's or other EDs?

 

[JacobMcCandles]

That's a sick set up. For those residents/attendings- at what point in residency are you typically allowed to moonlight? At what point did you feel comfortable moonlighting? Did the majority do it at UC's or other EDs?

Every residency is different. A few don't allow moonlighting, some allow it in PGY 2 & 3 years, and some allow it in PGY 3 only.

 

[Arcan57]

That's a sick set up. For those residents/attendings- at what point in residency are you typically allowed to moonlight? At what point did you feel comfortable moonlighting? Did the majority do it at UC's or other EDs?

Typically you'll be allowed to moonlight mid to late of the 2nd to last year of your program to the start of your last year. Often permission to moonlight is granted based on the program's perception of whether you are ready. That's a sliding scale depending on the strength of the resident.

Feeling comfortable moonlighting is highly personality dependent and I don't think anybody feels comfortable on their first moonlighting shift. Moonlighting (especially single coverage) is dangerous and your ability to tolerate/ignore the risk has only a loose association with your actual competence.

Most residents that moonlight will spend most of their time moonlighting in EDs, although starting out in UCs first is not unheard of. Take the numbers being thrown around with a grain of salt. Places where you are earning $90+/hr moonlighting in a UC are going to be rare.

 

[TeamZissou]

Thank you for the info

 

[LastMinEMROLQs]

question about nights, as it seems here to be the one of the biggest factors that is hindering EM from being a full-blown lifestyle specialty.

can you group them up??? say you're in a group can you do all nights for 2-3 months straight and be off of nights the next 5-6 months? or can you at least cluster up nights for about 3 weeks and then only do day/evening shifts for the next 2 months?

it seems the worst part about nights is the circadian shift in your schedule + losing those off days to recovery. so therefore, if you could limit the flip overs by clustering your nights, it would seem to take a big edge off this negative.

can private attendings out there comment on this/poke holes or validate in this theory?

 

[residentdoc8]

edited

 

[deleted109597]

I'm not an attending...

Or in an EM residency apparently, from my readings.

For those who have families, doing nights for 2-3 months means that you cannot spend quality time with your family because of opposing schedules (you need to work in sleep somehow before your next 12 hour shift while everyone in the household is awake, and you only see everyone at the end or beginning of your shift for a few hours....nevermind taking care of errands and other things that pop up in real life)...it just doesn't seem realistic or conducive to having a normal healthy balanced life. Then switching back over to your proposed months of days-- it's similar to jetlag, think of how long it takes you to adjust. Then think of how long it would take your body to adjust when you are in your 50's and not when you are in your 20's.

Continued bad assumptions. I would argue that while 12s may be common, so are 10s and 8s.
When I work nights, I get home right as my wife is leaving. She takes my son to preschool, and goes to work like she does when I'm on days. I usually sleep until she gets home, sometimes I wake up sooner. It's really not that different than when I work days, except that I leave right after dinner as she's putting my son to bed. Weekends are a bit different, but not that much.
Also, unless you're the "nights only" person, most groups only make you work 3-4 nights in a row at most, and usually that's your whole month's requirement of nights.

As a female, I cannot imagine finding a husband who would be willing to be a "house-husband" and do all the cooking, cleaning, child-rearing, going to child-play dates, laundry...etc....essentially being a "male wife" during those string of nights.....and even if you end up hiring help, that's more money out of your hard-earned paycheck. I think those who consider their field of medicine in their 20's have a different outlook when things change later in life and suddenly have others to think about. There are groups that allow those to only do days with a large hit in compensation, but it's do-able....and by days, I mean the latest shift could end at midnight.

EM has a good lifestyle if you can tolerate a few things- as with every specialty, the pros need to outweigh the cons. The only perfect specialty I can think of that would have a better control over lifestyle (meaning....a 9-5 regular-hour job with the highest compensation) would be derm (and maybe optho or ENT)- if you can tolerate such fields.

You hyperbolize a lot. We pay someone to clean the house not because we can't or are too tired, but because I can earn more during those 3 hours the cleaning crew is at the house than it costs for them to be there. I do mow my lawn, but that's not because I'm being frugal, it's because I like the exercise, and like taking care of it. Kid goes to daycare because we both work, so the idea of playdates when you both have jobs is a bit out there as well. Laundry can be done when you're both home. You seem to think that you work a lot more in EM than we actually do. It's not like we are never home. I'm home more days than I'm at work.

 

[EctopicFetus]

As McNinja said.. I had this discussion with one of the guys I work with. I have a pool guy, a maid etc. Its not like I dont know how to clean (never had a maid growing up), its that I HATE doing it. I would rather work than clean my house. The pool has more to do to make sure stuff gets done.

If I can pay someone to clean my house for about 30 mins of work thats a total no brainer for me.

 

[tkim]

Places where you are earning $90+/hr moonlighting in a UC are going to be rare.

Actually that's what I was getting while moonlighting.

 

[UnderwaterDoc]

Actually that's what I was getting while moonlighting.

If you don't mind me asking, where was this? I'm around your neck of the woods and I definitely want to moonlight.

 

[Lysinee]

How is it not lifestyle if you work twelve 12's in a month? I agree that the times might be a pain, but you aren't on call for 18 days.

Any opinions. Thanks.

 

[Bojack Horseman]

Any opinions. Thanks.

Read the thread? Every response essentially explains the answer to your question.

 

[Lysinee]

Premed, if you read my question carefully, I was asking specifcally about the lifestyle of twelve 12's in a month? Again, it wasn't discussed much in this thread.

Read the thread? Every response essentially explains the answer to your question.

 

[Bojack Horseman]

Premed, if you read my question carefully, I was asking specifcally about the lifestyle of twelve 12's in a month? Again, it wasn't discussed much in this thread.

Can you read in between the lines or not? Everyone is talking about finding a balance between the amount of time you want to spend at work, the amount of money you want to make, and the amount of time you want to spend with you family or do other stuff. No one can answer your any further because it's completely subjective and it's depends upon a multitude of factors including but not limited to: your marital status, whether or not you have children, your health, your monetary comfort level, and outside interests. Obviously, the less shifts you work the more time you will have to do whatever else you want to do. The more shifts you work, the less time you will have but the more money you will make. While you condescendingly refer to me as a premed, I take pride in the fact that I can sure as hell make an inference much better than you can. Maybe that's why no one has specifically addressed you're question: it has already been answered by multiple people.

 

[Apollyon]

Premed, if you read my question carefully, I was asking specifcally about the lifestyle of twelve 12's in a month? Again, it wasn't discussed much in this thread.

Combative much?

Remember, if everyone else has the problem, you are the one with the problem.

That anesthesia woman defended you, but she's about the softest touch on SDN. And you do have a documented history of not being clear (although, as you say, you don't state the obvious - even if it is obvious only to you).

 

[tkim]

If you don't mind me asking, where was this? I'm around your neck of the woods and I definitely want to moonlight.

That was in Buffalo during residency. I've moved away.

 

[HunterGatherer]

I also did UC moonlighting during residency and though it was busy - day after New Year's the NP and I saw 110 patients in 12 hours, it was a very slick setup, making it pretty easy to keep up.

What percentage of those patients are you telling to go to an ED because their chief complaint, comorbs, or H&P indicates a workup you cant provide?

 

[Lysinee]

So, we meet again after 6 months. I knew that name sounded familiar.

Mgirl gave good advice. She wasn't being nice on purpose.

That anesthesia woman defended you, but she's about the softest touch on SDN. And you do have a documented history of not being clear (although, as you say, you don't state the obvious - even if it is obvious only to you).

 

[Birdstrike]

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[Apollyon]

So, we meet again after 6 months. I knew that name sounded familiar.

Mgirl gave good advice. She wasn't being nice on purpose.

I didn't know how long it was, and I don't care. Your attitude is unearned, and not collegial, and you bring it on yourself. I don't care about anyone else, and I won't say "we all think", but I, individually, think that what you show is an adolescent and petulant mindset.

Student, realize your place - not as a student, but as a person. Good manners are always good policy. If someone slaps your cheek, give that person the other cheek. You take more than you give, because you don't yet have anything to give, and you are snotty about what you take.

And what do you mean "She wasn't being nice on purpose"? That's all she is. What, you think you are so unique that someone decided to be kinder and gentler to you than she is usually? You're not that special.

But, also, for your question, and as a counterpoint to birdstrike, 12s are my preference, and always have been. Doing the same work doesn't beat me up as badly as it apparently did him. Then again, I did nights for a year. 3 in a row is fine, and 4 if needed. 5 is a no-go. And I'm 41, and out of residency for 6 years.

 

[Lysinee]

Birdstrike, thanks for the supplemental info.

 

[Lysinee]

And you do have a documented history of not being clear (although, as you say, you don't state the obvious - even if it is obvious only to you).

I didn't know WTF you were until you said the last sentence in the quote above. Then, I had to look at my old threads to see. Talk about being bitter for a long time.

But, also, for your question, and as a counterpoint to birdstrike, 12s are my preference, and always have been. Doing the same work doesn't beat me up as badly as it apparently did him. Then again, I did nights for a year. 3 in a row is fine, and 4 if needed. 5 is a no-go. And I'm 41, and out of residency for 6 years.

tl;dr the other irrelevant info, for the last paragraph.

 

[Apollyon]

I didn't know WTF you were until you said the last sentence in the quote above. Then, I had to look at my old threads to see. Talk about being bitter for a long time.



tl;dr the other irrelevant info, for the last paragraph.

Yes, you are a ****. You're still a ****. You being a ******, still, doesn't make me bitter. It's all on you.

Or is that "too long" for you?

 

[residentdoc8]

edited

 

[deleted109597]

I would have to agree with the above post-- this forum is supposed to provide a realistic insight into the field of EM from those who have been there and done it. As a disclaimer, I am NOT an attending or a resident (....yet), I never claimed to be!,

Then change your user name.

but I was hoping to gather as much info. as I can to make a fully informed decision before I take the nosedive (this is a "studentdoctor" network after all)....the info. in this forum is useless to those who are already practicing (you've already made your decision!).

Well, I guess all the attendings/residents can leave then. Oh, wait, this is the Physician/Resident section, isn't it?

Hopefully others in a similar decision-making predicament can benefit from all of this info. (and by the way, i've done 5 months worth of EM (each attending seemed hesitant to say they would do it all over again if they had a choice...mainly because of the political medical-legal nature of medicine....

Where? In medical school? Pre-med?

although there aren't any other field that are able escape this)-- each day was exciting and wonderful, but exhausting, I always came home tired and drained and while it did ease up with each month, it never completely went away. This is ok for someone who is single without outside responsibilities (I could eat, sleep, and get up for my next shift without taking anyone else into consideration)....but I can't imagine doing this AND having a family).

Plenty do. Sure, it's not as easy as working only days, but then again, I get paid more, and I'm home more overall.

EM is a demanding field, because when you're on, you're on for the entire length of the shift- regardless of how tired you may feel, or how sick you may feel because inevitably you will catch something from at pt., or regardless of any other outside stressors- the EM doc is expected to STILL perform and make sound decisions. 90% of EM is primary care, but you're paid for that 10% when you have to admit a patient or nail the intubation/chest tube/etc which you have to be on your toes and prepared for any given shift.

So, you aren't in it, but proclaim to know what it involves? Sorry, but each shop is different. Some places aren't that demanding. And those places don't pay well usually, or are very rural, or are at the VA/Kaiser. A 10% admission rate would be a terrible day at my shop, we push 40% every single day. We often run at 50% capacity because of admissions holding downstairs.

As in all of my other posts- i'm comparing EM to UC. In UC, it sounds as though even when you're sick or dealing with any of the above issues, you're not dealing with anything that is life threatening- you can still go to work and put in your time and leave without wondering if any mistakes that could potentially cost your license have been made. It just sounds like a more sustainable career from the start, even though the money is relatively not really there.

Any field of medicine it is possible to make mistakes that are life/career threatening. Just because people choose to to go the urgent care center doesn't make them immortal. And sometimes it's worse, because you can't do much for the STEMI or appy that comes in the door, and you have to transfer it out.

There has to be a reason why you never see 70 year old full time EM docs in the ED- it's a difficult schedule/field to maintain for the life of a career....but maybe because EM is a relatively new field as compared to some others? Some EM docs transition to UC, but you still have to keep up your certification in EM every 10 years while you're not practicing it.

Because EM only started in 1970 as a residency, so that's part of the reason. Bruce Janiak is still listed as faculty at MCG (he was the first resident ever). You don't see a lot of 70 year old trauma surgeons, or critical care attendings either though. Mainly because at 70 you can't handle the physical demands of the job.
No matter what you do in UC, you'll have to maintain some certification likely, be it FM, IM, Med/Peds, or EM. The only things you do to maintain cert in EM are to retake the test every 10 years, keep your LLSA articles up and done, and get the Practice improvement activities done. It's not that difficult it just costs money.

 

[EM_Rebuilder]

I would have to agree with the above post-- this forum is supposed to provide a realistic insight into the field of EM from those who have been there and done it. As a disclaimer, I am NOT an attending or a resident (....yet), I never claimed to be!, but I was hoping to gather as much info. as I can to make a fully informed decision before I take the nosedive (this is a "studentdoctor" network after all)....the info. in this forum is useless to those who are already practicing (you've already made your decision!). Hopefully others in a similar decision-making predicament can benefit from all of this info. (and by the way, i've done 5 months worth of EM (each attending seemed hesitant to say they would do it all over again if they had a choice...mainly because of the political medical-legal nature of medicine....although there aren't any other field that are able escape this)-- each day was exciting and wonderful, but exhausting, I always came home tired and drained and while it did ease up with each month, it never completely went away. This is ok for someone who is single without outside responsibilities (I could eat, sleep, and get up for my next shift without taking anyone else into consideration)....but I can't imagine doing this AND having a family).

EM is a demanding field, because when you're on, you're on for the entire length of the shift- regardless of how tired you may feel, or how sick you may feel because inevitably you will catch something from at pt., or regardless of any other outside stressors- the EM doc is expected to STILL perform and make sound decisions. 90% of EM is primary care, but you're paid for that 10% when you have to admit a patient or nail the intubation/chest tube/etc which you have to be on your toes and prepared for any given shift.

As in all of my other posts- i'm comparing EM to UC. In UC, it sounds as though even when you're sick or dealing with any of the above issues, you're not dealing with anything that is life threatening- you can still go to work and put in your time and leave without wondering if any mistakes that could potentially cost your license have been made. It just sounds like a more sustainable career from the start, even though the money is relatively not really there.

There has to be a reason why you never see 70 year old full time EM docs in the ED- it's a difficult schedule/field to maintain for the life of a career....but maybe because EM is a relatively new field as compared to some others? Some EM docs transition to UC, but you still have to keep up your certification in EM every 10 years while you're not practicing it.
I guess it's all a personal decision-- I was just hoping to hear the absolute worst parts to the field because the good parts are so easy to list.

If you are 70 and only intend to work in UCs... I am rather certain most any place would be fine with you letting you ABEM certificate expire..espically since most would have re-cert 3-4 times by then!

Also... people on here are always talking about the '70 year old EM doctor'... and then say since those dont exist, then evidently EM is too tough to practice at 70... Not sure where you guys work, but I've met many of my shops Opthalmologists, Surgeons, IMs, Pediatrics, etc... and I can tell you that I am not so sure that my entire medical staff at our Level 1/Tertiary Care Center has someone still practicing at the age of 70... Maybe I am missing someone out there, but I assure you they are not plentiful.

Most of the rest world 'retires' before then, and I assure you many people WISH they could retire earlier. Most any physician that went right through schooling should have a million+ net worth in their 50s, and MOST should have much more than that.

When I am 70, I am going to spend time with my grandkids, wife, and trying to do anything else I am able to do before I am gone... If able, I might work a few shifts but I am certainly not going to 'plan on it'...

 

[tkim]

What percentage of those patients are you telling to go to an ED because their chief complaint, comorbs, or H&P indicates a workup you cant provide?

It's usually the chest or belly pain that we turn away. The chest pain, we call 911 and do an EKG while waiting for EMS. The belly pain we flat out tell them to go the ER.

Other than that, most people are good at self-selecting for UC. It's usually the same people who go to the ED, but have insurance, are willing to pay the copay, and don't want to wait.

 

[Birdstrike]

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[Birdstrike]

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[Birdstrike]

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[Birdstrike]

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[deleted103644]

Do people think the current level of salary in EM is sustainable? I would think this would be a prime location for cuts, since it doesn't make a huge amount of sense for emergency physicians to earn so much more per hour than hospitalists.

I'm not trying to start a flame war, just legitimately think it might be an issue. I see a lot of my classmates choosing EM almost entirely for it's current lifestyle which seems risky to me.

 

[Lysinee]

Yes, you are a ****. You're still a ****. You being a ******, still, doesn't make me bitter. It's all on you.

Or is that "too long" for you?

Name calling is considered immature and sets a low standard for yourself. If that's what you want to live up to, good for you.

 

[EM2BE]

Do people think the current level of salary in EM is sustainable? I would think this would be a prime location for cuts, since it doesn't make a huge amount of sense for emergency physicians to earn so much more per hour than hospitalists.

I'm not trying to start a flame war, just legitimately think it might be an issue. I see a lot of my classmates choosing EM almost entirely for it's current lifestyle which seems risky to me.

Do you realize the difference in stress levels between the 2 groups? How many medicine people have to worry about several critical patients at the same time? How many new patients do medicine see in a day? Remember in the ED, patients are all new patients.

Billing is based off RVUs. If you go to a billing lecture and learn why/where there are differences, you will understand how EPs get paid better than medicine.

 

[deleted103644]

Do you realize the difference in stress levels between the 2 groups? How many medicine people have to worry about several critical patients at the same time? How many new patients do medicine see in a day? Remember in the ED, patients are all new patients.

Billing is based off RVUs. If you go to a billing lecture and learn why/where there are differences, you will understand how EPs get paid better than medicine.

Aren't most emergency departments money losers for the hospital though? And I was under the impression critically ill patients are not kept in the ER for very long (unless there's an observation unit attached), they're sent to the OR or ICU.

Billing in medicine is very arbitrary and subject to regulatory change at any point. I would expect EM to be particularly vulnerable, since a large portion of current emergency care is just primary care for the uninsured.

 

[gutonc]

Aren't most emergency departments money losers for the hospital though? And I was under the impression critically ill patients are not kept in the ER for very long (unless there's an observation unit attached), they're sent to the OR or ICU.

Billing in medicine is very arbitrary and subject to regulatory change at any point. I would expect EM to be particularly vulnerable, since a large portion of current emergency care is just primary care for the uninsured.

Oh crap...here it comes.

 

[deleted103644]

Oh crap...here it comes.

Uh oh, I really wasn't trying to flame.

Did I say something really wrong? (Or just really controversial?)

 

[EM2BE]

Aren't most emergency departments money losers for the hospital though? And I was under the impression critically ill patients are not kept in the ER for very long (unless there's an observation unit attached), they're sent to the OR or ICU.

Billing in medicine is very arbitrary and subject to regulatory change at any point. I would expect EM to be particularly vulnerable, since a large portion of current emergency care is just primary care for the uninsured.

You need to go to a billing class. That will answer your questions. NEW PT visits are billed higher. Hence, all ED pts.

How long is not long in the ED? Have you been in a hospital yet? Many times our ICU is full and we are boarding the ICU pts.

Here is a LINK to a thread generated here about billing.

Here is a Presentation on RVUs and critical care time.

 

[ensuii]

Aren't most emergency departments money losers for the hospital though? And I was under the impression critically ill patients are not kept in the ER for very long (unless there's an observation unit attached), they're sent to the OR or ICU.

Billing in medicine is very arbitrary and subject to regulatory change at any point. I would expect EM to be particularly vulnerable, since a large portion of current emergency care is just primary care for the uninsured.

EDs generate admissions for hospitals. Although rates vary by location, I don't think the ED contribution is often negligible. Also, keep in mind that even community EDs see tens of thousand of patients that can range anywhere from 30 to 90k annually. That's hundreds of people a day getting labs and head-to-toe CTs.

Ideally a critically ill patient isn't in the ED very long but realistically the patient isn't going anywhere if they're not stable.

Every field is vulnerable to cuts. Relatively speaking, I don't see ED management of patients as being the crux of our medical woes. There's a significant percentage of uninsured patients that come in for routine primary care, which is unfortunate, but I think most EDs will have their share of serious acute illnesses. There's a reason why there's stress and burnout in EM and it's not because attendings are spending most of their time trying to adjust htn/dm2 meds.

 

[Birdstrike]

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[EctopicFetus]

johnnydrama.. you realize when you say

I would expect EM to be particularly vulnerable, since a large portion of current emergency care is just primary care for the uninsured.

this makes no sense and you likely have no understanding how billing works.

Where I work we bill for our own stuff. If a large portion of what I do is "primary care for the uninsured" I would be broke. where do you think the money comes from? Undoubtedly you either lack experience and have a skewed perception of what happens in ER or you are flaming. I will assume #1 and let you recommend you spend more time in numerous EDs and frequent this forum for those questions that arise.

I work at a level 1 trauma center that is also a stroke center and a chest pain center. OUr admit rate is 30+%. The hospitalist has their role and their skills that I dont. But I am far superior to them in procedures, caring for the critically ill, ortho, peds, lacs just to name a few things.. Throw in US, intubation, central lines and chest tubes..

Again hospitalists are key for their position but it is hard to compare our jobs.

 

[deleted103644]

johnnydrama.. you realize when you say this makes no sense and you likely have no understanding how billing works.

Where I work we bill for our own stuff. If a large portion of what I do is "primary care for the uninsured" I would be broke. where do you think the money comes from? Undoubtedly you either lack experience and have a skewed perception of what happens in ER or you are flaming. I will assume #1 and let you recommend you spend more time in numerous EDs and frequent this forum for those questions that arise.

I work at a level 1 trauma center that is also a stroke center and a chest pain center. OUr admit rate is 30+%. The hospitalist has their role and their skills that I dont. But I am far superior to them in procedures, caring for the critically ill, ortho, peds, lacs just to name a few things.. Throw in US, intubation, central lines and chest tubes..

Again hospitalists are key for their position but it is hard to compare our jobs.

Part of it may be that I'm mainly experienced with public hospitals. Most of the patients with insurance are on Medicaid/Medicare, and many are uninsured. I'm sure a good portion of the emergency care is not reimbursed and the hospital relies on additional government funding to make up for that shortfall.

You're right I haven't spent much time in the ER, but I have spent a few shifts there and a lot of time on the inpatient side of things.

From the outside, it really doesn't make sense to me that ER doctors are earning >$300k for <140hrs per month. I really have trouble believing that is sustainable.

 

[ensuii]

Part of it may be that I'm mainly experienced with public hospitals. Most of the patients with insurance are on Medicaid/Medicare, and many are uninsured. I'm sure a good portion of the emergency care is not reimbursed and the hospital relies on additional government funding to make up for that shortfall.

You're right I haven't spent much time in the ER, but I have spent a few shifts there and a lot of time on the inpatient side of things.

From the outside, it really doesn't make sense to me that ER doctors are earning >$300k for <140hrs per month. I really have trouble believing that is sustainable.

Uh...I can definitely think of a few other specialties where attendings make more doing less. 140hrs in EM puts a lot more wear and tear on you than 140hrs in Derm, general IM, etc.

 

[deleted103644]

Uh...I can definitely think of a few other specialties where attendings make more doing less. 140hrs in EM puts a lot more wear and tear on you than 140hrs in Derm, general IM, etc.

But general IM makes less, and I'd never be caught dead defending derm.

 

[WilcoWorld]

Part of it may be that I'm mainly experienced with public hospitals. Most of the patients with insurance are on Medicaid/Medicare, and many are uninsured. I'm sure a good portion of the emergency care is not reimbursed and the hospital relies on additional government funding to make up for that shortfall.

You're right I haven't spent much time in the ER, but I have spent a few shifts there and a lot of time on the inpatient side of things.

From the outside, it really doesn't make sense to me that ER doctors are earning >$300k for <140hrs per month. I really have trouble believing that is sustainable.

Part of your perception is likely related to your station. When I have a med student working with me, I pick the more primary care type cases for them, because I don't want them to have the responsibility of determining if a patient presenting 2.5 hours after symptom onset meets tPA criteria, doing a primary survey on a sick trauma patient, etc.