It’s almost mean to even mention this to medical students trying to decide on a speciality. By the time we are done with residency, EM will be lucky to be making $180/hr inflation adjusted, let alone the $320/hr you are talking about. Not sure if EM is worth $180-200/hr when your patients will scream, spit, and physically attack you more than any other speciality and you literally can’t turn them away if they show up tomorrow to do the same. You will never have a regular sleep schedule (unless you do only nights), and you spend half your shift on the phone talking to doctors that are mad you called.
EM has some cool aspects too, but telling stories about the golden days of EM is just a sad piece of history about how doctors sold their souls and our future to CMGs after making their own fortune.
I think you are reading wayyy to many negative nannies on the EM board. Sure EM is not as good as it was 5+ yrs ago where I would put it up against any specialty when you take into account it is 3 yrs.
You or I have no clue what the market will be in 3-5 yrs, no one does and it is useless to even predict. I heard the same thing 10 yrs ago and the gloom never came true. But you can say this for almost every specialty. You think Radiology is so great- ask them what the market was like 15 yrs ago.
All hospital based specialties complain like there is no tomorrow. Every time they came to the ER, they looked like someone stole their lunch money. Complaints left and right when I called them.
Patients never spit or physically attacked me. Maybe I am smart and stand far away from the dangerous looking one. Patients will scream and yell but its not that hard to walk away. Who cares if a stranger yells at you?
In 20 yrs of doing hospital based EM, I probably did 5 overnight shifts. We always had a nocturnist who we paid more. Even if we didn't have a nocturnist, I could always pay someone to do my nights. It all depends on if money or overnight sleep is more important to you. Did I also mention I never did Thanksgiving, Christmas, Christmas Eve? We just paid more and people picked them up.
To you point of a bad sleep schedule, I had a better sleep schedule than almost all of the specialist. I worked 9 hr shifts, 14 dys a month and avg about 450-500K plus benefits over 20 yrs. As I never did overnight, my latest shift was 1am, home by 130am, sleep by 2am where no one bothers me.
Talk to any OB/Gyn, Gen Surg, cards. Imagine having a full day schedule and taking overnight call. If they were lucky they would not get called in. But when they did and had a big surgery then they were up all night, then another full day clinic schedule the next dy. Miserable.
To your CMG point, almost every specialist is selling their souls. Radiology, Anesthesiology, Orthopedics, Cards, etc... Its rare to actually have an independent practice or small practice. Most are working for large hospital systems, CMGS, private equity and punch the clock just like most EM docs.