Em Salary?

[medapp_2018]

Hey everyone, interested in applying to EM in the future. Was wondering if anyone knows how much an emerg docs makes a hour? I've heard numbers $200-300 being tossed around. Also, does anyone know if emerg docs are allowed to incorporate?

[ploughboy]

It varies, and since compensation schemes vary between hospitals it's difficult to make a general statement. $300 000 a year for working a full line is probably a reasonable estimate.

 

Yes, ER docs can incorporate. Highly recommended, in fact.

[A.J.]

Do ER docs usually earn more than GPs due to the lower overhead they have?

[ploughboy]

Depends on the practice type, time worked etc but probably yes.

 

Don't focus on money though. Go into a specialty you think you'll be happy practicing for your whole career.

[futureGP]

bluebook from BC. search ER doc on ratemd. Find the name on bluebook for gross billing. Subtract 10-20%. Calculate personal income tax (worst-case scenario). 

[StevieRay]

It varies, and since compensation schemes vary between hospitals it's difficult to make a general statement. $300 000 a year for working a full line is probably a reasonable estimate.

 

Yes, ER docs can incorporate. Highly recommended, in fact.

Could you elaborate a little more on how ER docs can incorporate? In my understanding, you can incorporate only if you are work fee for service and not on a salary, which I understand is more common amongst ER physicians.

[ploughboy]

Could you elaborate a little more on how ER docs can incorporate? In my understanding, you can incorporate only if you are work fee for service and not on a salary, which I understand is more common amongst ER physicians.

 

Don't confuse receiving an hourly rate with being a salaried employee.  I can only speak to my experience, so let's use me as an example...

 

I'm not a T4 employee of the hospital.  I have a contract with my hospital (well, technically my professional corporation has a contract with the hospital) to provide medical services.    The contract includes very specific language:  "the physician is and shall remain at all times an independent contractor and shall not represent himself to be an agent, officer, or employee of [hospital name] or as being related to [hospital] in any way other than as an independent contractor.  Nothing in this agreement is intended to create nor shall be construed as creating the relationship of employer and employee...The physician is not entitled to any benefits [the hospital] makes available to some or all of its employees including vacation pay, medical benefits, disability benefits, pension plan, workers compensation..."

 

When it comes to compensation for my work in the ER, the contract basically says "refer to the agreement between the Emergency Group and the Ministry of Health".  That agreement says [heavily paraphrased] "ok, the MOH is going to give you a lump sum of money every month to make sure there's adequate ER physician coverage at the hospital, you guys figure out how you want to divide it up (oh, and we'll give you a percentage of shadow billings, too)" 

 

The group has decided to use most of that money to provide an hourly rate to the ER docs (the rate varies a little based on time of day).  They generate an invoice on my behalf, and pay that invoice out once a month into my corporate bank account.  There is no tax deducted at source, there are no CPP payments made on my behalf, there are no EI premiums paid by the ER group on my behalf.  It's strictly a "services rendered --> client invoiced --> invoice paid" kind of relationship.

 

Now I could be a salaried employee of my own professional corporation, but that wouldn't change the relationship between my corporation and the hospital.

 

Make sense?

[Economist]

Don't confuse receiving an hourly rate with being a salaried employee.  I can only speak to my experience, so let's use me as an example...

 

I'm not a T4 employee of the hospital.  I have a contract with my hospital (well, technically my professional corporation has a contract with the hospital) to provide medical services.    The contract includes very specific language:  "the physician is and shall remain at all times an independent contractor and shall not represent himself to be an agent, officer, or employee of [hospital name] or as being related to [hospital] in any way other than as an independent contractor.  Nothing in this agreement is intended to create nor shall be construed as creating the relationship of employer and employee...The physician is not entitled to any benefits [the hospital] makes available to some or all of its employees including vacation pay, medical benefits, disability benefits, pension plan, workers compensation..."

 

When it comes to compensation for my work in the ER, the contract basically says "refer to the agreement between the Emergency Group and the Ministry of Health".  That agreement says [heavily paraphrased] "ok, the MOH is going to give you a lump sum of money every month to make sure there's adequate ER physician coverage at the hospital, you guys figure out how you want to divide it up (oh, and we'll give you a percentage of shadow billings, too)" 

 

The group has decided to use most of that money to provide an hourly rate to the ER docs (the rate varies a little based on time of day).  They generate an invoice on my behalf, and pay that invoice out once a month into my corporate bank account.  There is no tax deducted at source, there are no CPP payments made on my behalf, there are no EI premiums paid by the ER group on my behalf.  It's strictly a "services rendered --> client invoiced --> invoice paid" kind of relationship.

 

Now I could be a salaried employee of my own professional corporation, but that wouldn't change the relationship between my corporation and the hospital.

 

Make sense?

What is the hourly rate like (roughly)? if you don't mind sharing. Of course it will vary between group by group I'm guessing, but should be relatively similar no?

[ploughboy]

What is the hourly rate like (roughly)? if you don't mind sharing. Of course it will vary between group by group I'm guessing, but should be relatively similar no?

 

Divide $300,000 by 12 months, divide that by whatever constitutes a full line at your institution (probably around 12 shifts per month), divide that by number of hours per shift and there's an estimate for  you.

 

That's only an estimate however, and is inclusive not only of base hourly rate but also percentage of shadow billings, WSIB billings, billings to out-of-province and out-of-country patients, billings to patients who opt-out of receiving OHIP benefits (eg: Mennonites), billings for treating Federal Gv't employees, OHIP billings rendered to hospitalized patients who aren't in the ER (eg: running codes on the ward), etc etc etc.

[estairella]

I think there is nothing wrong with knowing your future expected salary. The answer is quite variable though since it's quite dependent on which province you're in, your pay model (fee for service vs capitation/hourly) and work load (12 vs 20 shifts a month, weekday daytime vs overnight shift ratios, etc).

 

Ideally you should find what setting you want to work in and ask your preceptors what they earn.

 

I work fee for service in Ontario. I do my own billings. I average bill ~$3k/8hour shift (including private billings, workers comp, etc and mix of day, evening, weekends).

 

Some Ontario FFS make more than this, some less. Depends on what you see and how many pts you see. FFS has the potential to make more than salaried but will on average earn less per patient seen (compensated with higher pt volumes).

 

Billing codes in BC and Alberta are 'better' so you would expect FFS ER docs to do better there. I know BC capitation ER docs make generally less than Ontario ones though.

[LittleDaisy]

If you opt fee-for-service, it really depends on how efficient you are, and how involved you want to be in patients' care as an ER physician (i.e: taking care of a patient who will be staying in the ER for quite a few days, vs consult in internal medicine to take care of the rest). All depends on how many patients you saw in one shift, and what were their diagnoses? Any procedures you performed? Intubating, casts, wounds primary closure, all have different billing codes.

 

Also, having efficient residents and medical clerks, also give you the teaching premium and more patients volume. When I was in ER rotation, a few ER staff with over 20 years of practice, really trusted my clinical judgment, and only went to see patients for treatment explanations, or for discharge, or if the patients worried me. While as some ER staff would take the time to review, and go question the patient with me, and re-examine, and even insisted writing their own notes. It depends how comfortable you are in delegating tasks to your residents and med students (if you happen to teach in an academic hospital).

 

Also, if you work night shifts, evening shifts, the pay is higher (if you opt fee-for-service again) for every patient you see. Again, working night shifts disrupts your sleep cycle, and you rarely see your kids or loved one arriving home.

 

I have a feeling that most ER physicians prefer to be paid by fee-for-service, but this method is only lucrative if you are efficient, think quickly on your feet, love to do procedures, and focus on the important parts; be aware of your time limits as an ER physician, and knowing when to ask consultants for patients' management is crucial as well (that sums up the personality of an ER staff lol)

Divide $300,000 by 12 months, divide that by whatever constitutes a full line at your institution (probably around 12 shifts per month), divide that by number of hours per shift and there's an estimate for  you.

 

That's only an estimate however, and is inclusive not only of base hourly rate but also percentage of shadow billings, WSIB billings, billings to out-of-province and out-of-country patients, billings to patients who opt-out of receiving OHIP benefits (eg: Mennonites), billings for treating Federal Gv't employees, OHIP billings rendered to hospitalized patients who aren't in the ER (eg: running codes on the ward), etc etc etc.

[Aconitase]

It can be much more. Our in the west GTA (missisauga / Brampton) it’s a free for all. Quick GIM consults, some guys working 20-30 days a month and seeing large numbers. Sometimes 60 patients a shift. They are all over 600k. Depends a lot on where you work