EM is not a lifestyle specialty

[deleted103644]

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.

At our hospital the ED would not be making the decision on tPA at all, but I guess that might depend on whether or not the hospital is a stroke center.

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[txterp98]

I've administered TPA for strokes before neuro input as well as administered TPA for hemodynamically unstable PE's without cardiology/pulmonary input.

Just as you alluded to, the decision makers of these issues can vary based on practice settings.

 

[Apollyon]

Post a link please, so we can relive said flame war vicariously.

(curious, did you "*" your f bombs yourself or did SDN storm troopers do it for you?)

I starred myself. They weren't F bombs, though - however, I did not want to go afoul of the rules. Our mods not so much, but there is especially one mod on SDN that will swoop in and slap butts if you call someone a turd (irrespective of truth).

 

[deleted109597]

At our hospital the ED would not be making the decision on tPA at all, but I guess that might depend on whether or not the hospital is a stroke center.

Well your hospital apparently has a low opinion of the utility of EM trained professionals. Or they want to spread the liability over more people.

 

[EctopicFetus]

At our hospital the ED would not be making the decision on tPA at all, but I guess that might depend on whether or not the hospital is a stroke center.

I work at a stroke center.. i make those decisions myself on occasion. 300k is not avg for em.. IMO we are underpaid esp if the acuity is high and you are busy.

 

[deleted103644]

I work at a stroke center.. i make those decisions myself on occasion. 300k is not avg for em.. IMO we are underpaid esp if the acuity is high and you are busy.

I'm not making any comments about how much any specialty deserves to be paid. I just know a lot of my classmates went into EM specifically for lifestyle and I was just wondering if that might have been shortsighted.

Are you guys sure hospitals won't push for more hours in the future, possibly at lower compensation? It might burn out physicians faster, but a cynical administrator might see that as a positive (pushing out the old/expensive for the new/cheap).

 

[EctopicFetus]

I'm not making any comments about how much any specialty deserves to be paid. I just know a lot of my classmates went into EM specifically for lifestyle and I was just wondering if that might have been shortsighted.

Are you guys sure hospitals won't push for more hours in the future, possibly at lower compensation? It might burn out physicians faster, but a cynical administrator might see that as a positive (pushing out the old/expensive for the new/cheap).

There are numerous setups. Perhaps its working for EmCare, Teamhealth etc. In the end it comes down to supply and demand.. right now demand is high.

Other practice styles exist. My group has a contract with the hospital. We are not their employees. We do our own billing so our income is dependent on our billing and not on what the hospital thinks they should pay us.

Few EDs (some rural ones) work in a vacuum. Rural EDs have an exceptionally tough time getting docs. If I work in a city/county where there arent enough docs and my hospital wants to cut my pay Ill just leave. Few cities have enough docs. SD is one. Some of the resort towns who dont need a ton of docs are really tight too. Other than that you see all those classifieds in the ED journals? Supply does not equal demand... When it does Ill be happy I am a partner in my group.

 

[EctopicFetus]

johnnydrama... curious what field you went in to?

 

[deleted103644]

johnnydrama... curious what field you went in to?

Haha, radiology, but before you judge, it was primarily for the tech, not lifestyle. I fully expect it to get cut to shreds and my colleagues expecting high income for little work to be sorely disappointed.

 

[KiloAxe]

Haha, radiology, but before you judge, it was primarily for the tech, not lifestyle. I fully expect it to get cut to shreds and my colleagues expecting high income for little work to be sorely disappointed.

too late, we are already judging. especially since you feel that ED physicians are overpaid at 300k. I wonder what your thoughts are on the radiologists who start at 500k a year?

 

[deleted103644]

too late, we are already judging. especially since you feel that ED physicians are overpaid at 300k. I wonder what your thoughts are on the radiologists who start at 500k a year?

Also overpaid, and those jobs don't exist anymore.

Most radiologists coming out of fellowship right now are earning <$300k and definitely working more than 140hrs a week.

 

[deleted103644]

Also overpaid, and those jobs don't exist anymore.

Most radiologists coming out of fellowship right now are earning <$300k and definitely working more than 140hrs a week.

Oops, meant month.

 

[LastMinEMROLQs]

too late, we are already judging. especially since you feel that ED physicians are overpaid at 300k. I wonder what your thoughts are on the radiologists who start at 500k a year?

LOL at johnnydrama, who is in rads, coming to this forum to complain about EM's hours to pay ratio............

 

[deleted103644]

LOL at johnnydrama, who is in rads, coming to this forum to complain about EM's hours to pay ratio............

Not complaining, just don't think it's going to remain high in the future. Hospitals could easily ask for more hours at the same salary if the supply of EM docs goes up a bit.

I have several friends going into EM for lifestyle and just think they'll be disappointed.

 

[deleted109597]

Hospitals could easily ask for more hours at the same salary if the supply of EM docs goes up a bit.

Again, hospitals don't pay the salaries of most EM docs. We aren't hospital employees. We just work there.

 

[GeneralVeers]

Our staffing is decided at the group level and not by the hospital. Certainly the hospital can ask us to look at staffing during certain hours if patients tend to be waiting. Usually we move shifts around a bit or add PA hours. For most docs in our area they aren't going to accept compensation less than $150/hour. Going below that would mean losing experienced docs who are familiar with the hospital system. Definitely a negative.

 

[deleted103644]

Again, hospitals don't pay the salaries of most EM docs. We aren't hospital employees. We just work there.

I think the trend is against you there though - I would bet those arrangements switch to hospital employee models in the future, at least in desirable locations. This will be the case for many specialties, not just EM. The current arrangement is better for physicians, but we don't really have the political clout to keep it that way. (Same thing is happening in radiology, I expect most of the private practice groups to either be absorbed by large national groups or by hospitals, resulting in decreased wages and increased hours.)

If someone is really interested in a specialty I have no issues with them going into it, I just see many people choosing based almost entirely on lifestyle perks that will likely disappear and I think that's short-sighted.

 

[SoCuteMD]

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.

The only way ERs are money losers for hospitals is if the numbers are interpreted in a vacuum. Once you account for the fact that in some institutions, ER visits fill as many as 75% of the beds in the hospital, and hospital stays are what generate income, the ER suddenly looks like a money earner.

 

[EMandM]

I think the trend is against you there though - I would bet those arrangements switch to hospital employee models in the future, at least in desirable locations. This will be the case for many specialties, not just EM. The current arrangement is better for physicians, but we don't really have the political clout to keep it that way. (Same thing is happening in radiology, I expect most of the private practice groups to either be absorbed by large national groups or by hospitals, resulting in decreased wages and increased hours.)

If someone is really interested in a specialty I have no issues with them going into it, I just see many people choosing based almost entirely on lifestyle perks that will likely disappear and I think that's short-sighted.

Started to compose a response discussing what's happened to rads reimbursement and the fact that you have very little actual knowledge of ED staffing or what the related trends are. Decided to let other, more knowledgable people address that stuff with you. What I do want to say is that I find your presence on SDN in general to be creepy and excessive. You were just incredibly involved in the scramble threads despite having no real reason to be there, and now you're here starting arguments about the future of EM reimbursement. Go outside, have a beer, just do something other then stir up trouble on SDN.

 

[deleted103644]

Started to compose a response discussing what's happened to rads reimbursement and the fact that you have very little actual knowledge of ED staffing or what the related trends are. Decided to let other, more knowledgable people address that stuff with you. What I do want to say is that I find your presence on SDN in general to be creepy and excessive. You were just incredibly involved in the scramble threads despite having no real reason to be there, and now you're here starting arguments about the future of EM reimbursement. Go outside, have a beer, just do something other then stir up trouble on SDN.

Haha, as I said, wasn't intentionally stirring up trouble. Blame the SDN iPhone app for my excessive posts recently (many have been made outside), makes it too easy to see replies. Isn't it "creepier" that you went through my old posts? Thought SOAP was interesting and even if not directly applicable to me, it helped kill time that might have been spent worrying about where I matched.

I'll admit I'm pessimistic about physician reimbursement, doesn't mean I'm not realistic. I'll leave you guys alone now, try to lay off the personal attacks, they make you look petty/insecure. I originally posted because I was generally curious, was not attacking your profession.

 

[otacon88]

I think the trend is against you there though - I would bet those arrangements switch to hospital employee models in the future, at least in desirable locations. This will be the case for many specialties, not just EM. The current arrangement is better for physicians, but we don't really have the political clout to keep it that way. (Same thing is happening in radiology, I expect most of the private practice groups to either be absorbed by large national groups or by hospitals, resulting in decreased wages and increased hours.)

If someone is really interested in a specialty I have no issues with them going into it, I just see many people choosing based almost entirely on lifestyle perks that will likely disappear and I think that's short-sighted.

Not trying to start a flame war, but you've literally said the same thing about 7 different times, and you've had multiple people tell you how it is. What's it to you how ER docs are staffed and compensated? Just because you went into Rads and you think there will be cuts and shortages there, are you trying to convince people in other specialties they're going to encounter the same fate? Seems like you have a "If I go down I'm taking everyone else with me" mentality, but without any real evidence to back it up.

 

[deleted103644]

Not trying to start a flame war, but you've literally said the same thing about 7 different times, and you've had multiple people tell you how it is. What's it to you how ER docs are staffed and compensated? Just because you went into Rads and you think there will be cuts and shortages there, are you trying to convince people in other specialties they're going to encounter the same fate? Seems like you have a "If I go down I'm taking everyone else with me" mentality, but without any real evidence to back it up.

Really, my posts here had nothing to do with rads - as I said, went into it because it interests me, not for any financial reason, and only mentioned it because someone asked. Our ER guys are hired by the hospital, so it's not like the PP model is universal, and the pressure on all specialties is a reduction in private physician groups.

I have no regrets about my choices, and I know people who are legitimately interested in EM who I'm sure will be fine whatever happens. It's the people being drawn in by the high salary, ridiculously low hours of EM that I'd wager will be disappointed in the future.

 

[Arcan57]

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.

We see high numbers of sick, COMPLEX patients for the 1ST TIME while frequently performing procedures that are assigned moderate RVU values. Yes, EPs can get screwed if Medicare funding (and thus private insurance) payments are slashed across the board without a subsequent improvement in payor mix (ie fewer uninsured). It's very difficult to devise a plan to nerf EP income selectively without creating a new set of CPT codes related exclusively to ED evaluation. And I don't think there's enough public or private outrage about the fat-cat EPs to force an overhaul of the system.

The government is hemorrhaging money on in-patient length of stays, end-of-life ICU care, and the worsening baseline health of the American population. Evangelical Christians have pretty much canceled any ability to deal with reason #2 at a national or state level, and reason #3 is based on the nation's very bed-rock of "personal freedom with only minimal personal responsbility" that has defined us since the Baby Boomers. In-patient/out-patient IM unfortunately is in the crosshairs because they control a tremendous amount of Medicare spending. CYA consulting on the inpatient side (pt has a hx of CHF better get cards, pt has a hx of CRI better get nephrology, pt had a syncopal episode better get neuro) in particular is going to be targeted because it adds quite a bit to length of stay and often doesn't improve the patients care unless the paient needs a procedure or has a true zebra (which is uncommon),

 

[Apollyon]

It's the people being drawn in by the high salary, ridiculously low hours of EM that I'd wager will be disappointed in the future.

There's your bunghole, and then there is you talking out of it.

120-144 hrs/month for EM. A good friend of mine is a partner in her rads group. How many shifts per month do they work? On average, 9. 8 hour days, 9 days a month. 72 hours. If it wasn't for her privacy, I would tell you the group - but they are NOT unique.

 

[Birdstrike]

.

 

[WilcoWorld]

If someone is really interested in a specialty I have no issues with them going into it, I just see many people choosing based almost entirely on lifestyle perks that will likely disappear and I think that's short-sighted.

Aside from the "likely disappear" part, it would appear that you're point is that you agree with the original post.

 

[EctopicFetus]

Also overpaid, and those jobs don't exist anymore.

Most radiologists coming out of fellowship right now are earning <$300k and definitely working more than 140hrs a week.

You better talk to more people... My buddy is finishing neurorads and def getting over 300k.. perhaps location is the issue?

 

[EctopicFetus]

Guys.. it is obvious johnny has little knowledge of the broader spectrum of medicine and even his own field. Perhaps rads are only getting 300k where he is at but thats not the case with my rads buddies. I would guess academics makes way better than that and I know thats true here in AZ.

With respect to hospitals running their own EDs/rads depts thats gonna be unlikely. Most of EM is rather transient. 50% of EM grads leave their job within the 1st 2 years. The hospital doesnt want to spend its time dealing with this. I would doubt they could do this in an efficient manner. While I oppose all that is EmCare/TeamHealth etc (as mentioned before) I find that to be a significantly better option than being a hospital employee.

On another note we are starting to see the failure in the hospital run hospitalist programs (at least here in the phoenix area). I think most realize they are better served not trying to control doctors. We are a tough bunch to control.

 

[EctopicFetus]

A few other take home notes.. It seems like most of the more experienced docs on here dont feel it is a lifestyle specialty while the residents and med students feel otherwise. There are perhaps a few who feel differently.

Most of what i heard was "how could it not be" stuff. Thats been discussed. I love EM, I love my group but its hard on my family and therefore hard on me. When I work a long stretch my kids tell me how bad they miss me and it breaks my heart. Perhaps this si true in other fields too.. perhaps worse.. but that enough makes it harder than a standard 9-5.

 

[deleted103644]

You better talk to more people... My buddy is finishing neurorads and def getting over 300k.. perhaps location is the issue?

It is to some extent, and that's probably the cause of some of the disagreement in this thread too (economic realities in my region may be very different). Partnership tracks are also disappearing and PP groups are getting fired and replaced by telerads or hospital employee models. There are still some old-timers earning ridiculous amounts with low hours, but that will change quickly and those paths are barely accessible to current graduates. I expect they'll be gone by the time I finish residency, but I was planning on academics anyway where I will be happy earning anything over $200K.

 

[deleted103644]

Guys.. it is obvious johnny has little knowledge of the broader spectrum of medicine and even his own field. Perhaps rads are only getting 300k where he is at but thats not the case with my rads buddies. I would guess academics makes way better than that and I know thats true here in AZ.

My region is low paying, most PP jobs are $200-350K and tough to come by unless you are fellowship-trained in IR or mammography. Academic jobs are $150k to $250k. I'm sure AZ earns more. I'll leave you guys alone now, didn't mean to cause so much trouble.

 

[EctopicFetus]

My region is low paying, most PP jobs are $200-350K and tough to come by unless you are fellowship-trained in IR or mammography. Academic jobs are $150k to $250k. I'm sure AZ earns more. I'll leave you guys alone now, didn't mean to cause so much trouble.

Im guessing california.. i dont know where else this level of inequity would be tolerated. Johnny if you plan for 150k I think you will simply be happy when the time comes assuming Obamacare doesnt ruin the whole system for us.

Keep in mind lawyers make 300k too.. its not that hard you simply have to be smart and want to work for a firm and not do public work.

If they cut doc pay by 30% (for example) you will see the old dudes leaving quickly.. that will fix the cash problem..

 

[CopToEM]

A few other take home notes.. It seems like most of the more experienced docs on here dont feel it is a lifestyle specialty while the residents and med students feel otherwise. There are perhaps a few who feel differently.

Most of what i heard was "how could it not be" stuff. Thats been discussed. I love EM, I love my group but its hard on my family and therefore hard on me. When I work a long stretch my kids tell me how bad they miss me and it breaks my heart. Perhaps this si true in other fields too.. perhaps worse.. but that enough makes it harder than a standard 9-5.

This kind of raw emotion is what needs to be shared with pre-meds and, I feel, is not done so nearly often enough. Hence why many have Illusions of Grandeur about life as a physician. Maybe I'm just a realist and see past it all and understand, going into it, that your sentiments will likely become my own at some point.

A physician mentor told me after my acceptance, "You can either be a GREAT physician or a GREAT family man. You can't be both. You can however be a decent physician and a decent family man. It's up to you to decide for yourself." Based on your experiences and the comment you made above - how do you feel about that? If it has merit, do you feel that's true of only physicians in some specialties or all specialties?

 

[EctopicFetus]

This kind of raw emotion is what needs to be shared with pre-meds and, I feel, is not done so nearly often enough. Hence why many have Illusions of Grandeur about life as a physician. Maybe I'm just a realist and see past it all and understand, going into it, that your sentiments will likely become my own at some point.

A physician mentor told me after my acceptance, "You can either be a GREAT physician or a GREAT family man. You can't be both. You can however be a decent physician and a decent family man. It's up to you to decide for yourself." Based on your experiences and the comment you made above - how do you feel about that? If it has merit, do you feel that's true of only physicians in some specialties or all specialties?

I dont know. I think it depends. I aim to be a GREAT family man and a very good (not great physician). If I wanted to be great I would have done academics. For me it has to do with my group. I work for a pretty high compensation group. I think thats the key. It also depends on how much money you need.

If you are making $250/hr and "need" 250k you could work 80 hours a month. I dont think 250/hr is impossible to find. For me I maximize my time when kids are in school. I work nights to do this. They go to school/daycare I sleep. I work more than that thanks to student debt.

I think EM gives the greatest potential outside of derm and some others to be there for your family. Long term i want to hit 120 hours a month. I have a firm goal of having enough money to retire in 17 years. My family however comes first and if I dont have the money til im 55 but can enjoy my kids then so be it.

to the above poster.. EM is all about how you use your time. You will have plenty of it. Some of it may be when you are exhausted.. Dont take that out on your spouse or kids. My way is to just be very quiet. I dont want them to think I am mad at them when I am just tired.

I think being on call is a family and lifestyle killer esp if you have to come in to work at all hours like ortho and some others. Hope this helps..

There is a definite romance in EM. People need to be more realistic. The question regarding family comes down to how much money you NEED.. the more you need to worse it will be on your family. Keep a simple life, no yachts, maseratis, or million dollar homes and it becomes easier.

 

[Arcan57]

This kind of raw emotion is what needs to be shared with pre-meds and, I feel, is not done so nearly often enough. Hence why many have Illusions of Grandeur about life as a physician. Maybe I'm just a realist and see past it all and understand, going into it, that your sentiments will likely become my own at some point.

A physician mentor told me after my acceptance, "You can either be a GREAT physician or a GREAT family man. You can't be both. You can however be a decent physician and a decent family man. It's up to you to decide for yourself." Based on your experiences and the comment you made above - how do you feel about that? If it has merit, do you feel that's true of only physicians in some specialties or all specialties?

Work, play, family - you can be excel at 2 of the 3, at least in EM.

 

[residentdoc8]

edited

 

[SeekerOfTheTree]

If melatonin works for you life is good

 

[Arcan57]

I still have reservations of constantly feeling jetlagged (even 1 or 2 nights a month would kill me if I had to do it for 20+ years)

Go ahead and cross EM off of your list of specialties you'd be happy in. Not being mean or dismissive, just letting you know that your chances of ending up in a job with no nights is low enough that you should just move on.

 

[tkim]

Go ahead and cross EM off of your list of specialties you'd be happy in. Not being mean or dismissive, just letting you know that your chances of ending up in a job with no nights is low enough that you should just move on.

Though if you can find a group that has dedicated nocturnists, you've struck gold.

 

[Arcan57]

Though if you can find a group that has dedicated nocturnists, you've struck gold.

Not saying they don't exist at all, but even with nocturnists most EPs are still going to be working at least 1 night shift/month.

 

[tkim]

Not saying they don't exist at all, but even with nocturnists most EPs are still going to be working at least 1 night shift/month.

My group has one, so we all only work 2 nights/month. If we get another nocturnist and drop the requirement to 1/month or less I would do the Snoopy dance.

 

[DrMom]

Not saying they don't exist at all, but even with nocturnists most EPs are still going to be working at least 1 night shift/month.

I'm one of 5 nocturnists in my group (covering 3 community hospitals). The other docs still mostly work 2 nights a month. There isn't anyone that has no night shifts.

 

[EM_Rebuilder]

I'm one of 5 nocturnists in my group (covering 3 community hospitals). The other docs still mostly work 2 nights a month. There isn't anyone that has no night shifts.

We have three nocturnists; everyone else does 2 weeks (6-7 shifts) about every 5 months or so... supposed to work out to twice a year? I havent been here a year yet though. The options of the group was 1-2 nights per month, 6-7 twice a year, or one month of nights a year and everyone picked the middle. The fourth noctunsits left as I came; before that nobody really worked nights except the night guys.

When its not your 'nights month', we have to work 1 to 3 swing (3p-3a) shifts.


I honestly think going forward, we are going to see more people choose to be nocturnists... espically with as 24/7 the world ihas become. I can eat a full meal out at 3AM, go to several stores.. I've even mowed then. I cant imagine 20 years ago when the only thing open past 7PM was a shady bar. The key is having a night dif that awards people for doing such. Most night difs are rather significant when added up over a year (50-100K) so that becomes attractive...

But, I agree, anyone looking at going into EM should 'plan on working nights', but know there are some options out there...

 

[EctopicFetus]

Not saying they don't exist at all, but even with nocturnists most EPs are still going to be working at least 1 night shift/month.

my group has 4 nights shifts a day.. we have 8 nocturnists and the $40/hr diff is enough that even as others want to go to nights there is no room.

our policy is 20 yrs in the group no nights except if called on backup. most guys end up with 1 night every 6 months when it just cant get covered.

 

[docrower]

This thread is really gold from a student's perspective, really good arguments for/against EM as "lifestyle" (whatever that means) and dispelling myths. Perhaps mods should consider adding this to the mother sticky? Thanks to everyone who has/is contributing, it has been a truly enlightening thread.

 

[Silent Cool]

Medicine is a lifestyle specialty, physicians just aren't lifestyle people.

I think you might be right. Well said.

 

[RustedFox]

I'll play once again.

I'm seven months into attendingland.

I'm pretty satisfied. Sure, there have been ups and downs, but for the time that we work (I usually pull between 140-150 hours a month), the pay is pretty great. Random thoughts:

1. I didn't take into account "startup costs" of a new place/life. We moved here without a splinter of furniture. What we had back in ResidentLand was cheap, disposable, or sold. Buying "real" furniture is a freaking racket. I was a hard@ss about "shopping around". It made no difference: I was still offended that so many stores wanted 125-175 dollars for... a nightstand. My feet are up right now on a 300 coffee table. Granted, the thing has major-league storage and is finished like an olde marine chest, but maan... Furniture added up like, whoa.

2. I work a decent amount of nights/weekends. We don't have kids (never will) and the wifey doesn't work (for now), so there's no difference between weekdays/weekends. The only real "difficult" part is the "one day off" between night shifts and anything else (days, afternoons). Its hard to wind it back that quickly.

3. The most challenging aspect of the job so far is "getting all the charting done in a realistic time period". We just had a meeting with various parties (the admin folks, the medical records folks, us), and there seem to be two "warring" interests. The admin folks want everyone seen at lightspeed and their precious "times" to stay down. The medical records folks want all their charts done by the end of the shift. Every single one of the "group" docs (except one) said - "lf you want the charts done on-time, people are going to HAVE to wait. Pick one." All parties just grumbled and no resolution was reached.

4. I love having stretches of 3-4 days off in a row 2 or 3 times a month. My recreation time is freaking awesome.

 

[Old_Mil]

No, it really isn't a lifestyle specialty for all the reasons mentioned here. I expect that it is going to get disproportionately worse with Obama care and the prevailing school of thought in EM leadership circles that 'at least we will have more insured patients' is fairly shortsighted.

In fact I would recommend a medical student going into the match think long and hard before committing to a field where the vast majority of jobs require you to buy all your benefits on the retail market.

Furthermore, the 220-250 an hour rates are out there... But most ed jobs seem to pay 100-150.

Sent from my A110 using Tapatalk 2

 

[EctopicFetus]

No, it really isn't a lifestyle specialty for all the reasons mentioned here. I expect that it is going to get disproportionately worse with Obama care and the prevailing school of thought in EM leadership circles that 'at least we will have more insured patients' is fairly shortsighted.

In fact I would recommend a medical student going into the match think long and hard before committing to a field where the vast majority of jobs require you to buy all your benefits on the retail market.

Furthermore, the 220-250 an hour rates are out there... But most ed jobs seem to pay 100-150.

Sent from my A110 using Tapatalk 2

Pay is highly dependent on your location. If you live outside of the big cities in Cali or the northeast or other pockets like Denver etc the money is there at 200/hr+.

I know I may be in the minority but the large CMGs will be the end of EM as a decent specialty.

 

[RustedFox]

Pay is highly dependent on your location. If you live outside of the big cities in Cali or the northeast or other pockets like Denver etc the money is there at 200/hr+.

I know I may be in the minority but the large CMGs will be the end of EM as a decent specialty.

Old Mil: Are you sure its not just "my first job sucks" syndrome that's what's got you down?

I'm not asking to flame; I'm wondering what the details are that you hate.

I work for a large CMG in urban Florida. 175 hour. Employee position; full benefits.

Also *just thought* - maybe its the 1099 status that you hate. I'd hate having to deal with all the ins-and-outs of buying my own insurances, etc. That would suck me dry seeing all of "my" money go to the intangibles.

EF is dead-on, though. If I didn't "have" to work for a CMG (they own my area; there's two warring factions), I wouldn't. At all.