How do emerg docs get paid?

[takewhatsmine]

I was wondering what the payment model is for emergency physicians in ontario...is it fee for service, ie. variable by volume, or is it set amout per shift or hour, ie. standard regardless of volume?

[The_B]

Usually by the hour in the 120/hr range or salary in academic centers. There are many variations of course. There are still a few that do fee for service, some do per hour and get % of billings. There certainly isn't one standard model, every place has their own set up.

[White-Tiger]

Usually by the hour in the 120/hr range or salary in academic centers. There are many variations of course. There are still a few that do fee for service, some do per hour and get % of billings. There certainly isn't one standard model, every place has their own set up.

 

I always find it kind of odd how in you get paid less in academic centers compared to peripheral hospitals. I see tons of ads for emerg paying 150-175-200$/h outside of huge centers. You would think it should be the other way around considering the acuity of the cases that come to academic centers...

[monkey799]

150-175 per hour is about right

 

I know Emerg docs makes around 200-250k doing on average 14 8-hour shifts per month

 

hence

 

150/hour x 8 hrs/day x 14 days/month x 12 month/year = 201600

 

175/hour x 8 hrs/day x 14 days/month x 12 month/year = 235200

 

120 per hour is probably on the lower end

[leviathan]

I always find it kind of odd how in you get paid less in academic centers compared to peripheral hospitals. I see tons of ads for emerg paying 150-175-200$/h outside of huge centers. You would think it should be the other way around considering the acuity of the cases that come to academic centers...

Supply and demand.

[White-Tiger]

Supply and demand.

 

Well, im not complaining, planning to work in the periphery lol.

[xyz]

The emerg doc in the academic centre also has an army of specialists and sub specialists to consult. In the periphery there is usually help but not necessarily in house immediately (no residents) and not as specialized (i.e. general internal medicine call instead of individual cardio, resp, GI call). Therefore, the periphery emerg doc needs to be quite self-sufficient.

[leviathan]

The emerg doc in the academic centre also has an army of specialists and sub specialists to consult. In the periphery there is usually help but not necessarily in house immediately (no residents) and not as specialized (i.e. general internal medicine call instead of individual cardio, resp, GI call). Therefore, the periphery emerg doc needs to be quite self-sufficient.

The infamous paradox. You see the same with paramedics...lots of ALS available in big cities because there is a high enough call volume and sick enough patients to demand their presence. However, it is the rural towns with long transport times to hospital that could benefit the most from ALS, although the frequency they would be needed is less.

[BigM]

I read somewhere that there is no difference in pay between the 2+1 CCFP and the 5 year emerg specialized docs, is this the general consensus when it comes to hourly salary?

[crockett]

I read somewhere that there is no difference in pay between the 2+1 CCFP and the 5 year emerg specialized docs, is this the general consensus when it comes to hourly salary?

 

Yes. I'd actually argue that 2+1 tend to make more (since the 5 yr ER docs would tend to be in academic centres), but comparing positions at the same hospital they would be paid equally.

[rmorelan]

Yes. I'd actually argue that 2+1 tend to make more (since the 5 yr ER docs would tend to be in academic centres), but comparing positions at the same hospital they would be paid equally.

 

Yeah those extra 2 years aren't going to grant you any extra pay anywhere really. I have been told it probably will help you get hired at a particularly location though (which I suppose makes sense)

[BigM]

Yes. I'd actually argue that 2+1 tend to make more (since the 5 yr ER docs would tend to be in academic centres), but comparing positions at the same hospital they would be paid equally.

 

Its unfortunate that the additional two years aren't compensated. This is a huge amount of speculation on my behalf as I'm still pre-med, but emergency medicine in a rural area is something that sounds/looks appealing. I feel that the 5 year program would be hugely beneficial to someone practicing rural because of the difficulty in accessing specialists and the potential distance from the nearest trauma or CCU. However, if I was sure emerg in a rural area is what I wanted to do, I don't feel that the extra training alone would be enough incentive for me to sacrifice the flexibiltiy of the 2+1 which would allow me to start my unsupervised practise two years earlier and have the potential to do family practise.

 

This really seems like a situation where the compensation should match the level of training, granted the pay for emerg physicians is pretty sweet either way.

[White-Tiger]

If you're doing the same job, you should be paid the same...

 

Besides, if anything, a family doctor trained in emerg is probably more useful in a rural location. A *LOT* of the patients coming in to the ER come with complaints that should be addressed in a family medicine clinic but since there's not enough they overflow to the ER.

 

And in terms of those high-acuity cases you speak of...all the ER doctor in the periphery is going to do is his best to stabilize the patient while he's transfered to a major center...

[leviathan]

If you're doing the same job, you should be paid the same...

 

Besides, if anything, a family doctor trained in emerg is probably more useful in a rural location. A *LOT* of the patients coming in to the ER come with complaints that should be addressed in a family medicine clinic but since there's not enough they overflow to the ER.

That's actually more of an urban problem you're describing, at least out in BC. Patients in rural areas usually only have their family docs working at a combo clinic / urgent care centre with a little resusc. room so they deal with both ER and scheduled + walkin family practice patients in the same place.

 

And I think a 5 year royal college EP would be much more desirable in a rural area, at least compared to a CCFP-EM who's fresh out of residency. I've heard lots of scary stories about GPs or GPs with the +1 year in ER who were not prepared to work by themselves out in a rural town with no specialists or backup from other MDs. A brand new CCFP-EM would be better suited to work in an urban centre where they have lots of backup if needed. And that's not just my opinion, the MDs themselves admit they don't feel prepared to go out and work in a rural town.

 

It's not an issue of intelligence or anything, it's just a lack of experience of someone who gets 2 years of family med with maybe a few EM rotations and then 1 dedicated year of EM, compared to someone who gets 5 dedicated years in EM. If you compare a CCFP-EM who's actually got 10+ years of experience in a busy urban ER, they'd probably be just as competent as any FRCPC physician with equivalent years of experience. Either of those would be suitable for a rural environment.

[NorthernDude]

I know a fair number of Emerg 2+1 docs, and one of them quoted a study that found that after the same amount of time in practice, say 5 years (as I don't remember the actual time frame), you don't see a difference between a CCFP and a 5 year ER, in terms of competency and outcomes.

 

The centre I'm in has a population of ~150,000 and has an ER with one of the highest acuities in Ontario, and is staffed almost exclusively with 2+1s. It works here very well.

[Julie]

I've heard lots of scary stories about GPs or GPs with the +1 year in ER who were not prepared to work by themselves out in a rural town with no specialists or backup from other MDs. A brand new CCFP-EM would be better suited to work in an urban centre where they have lots of backup if needed. And that's not just my opinion, the MDs themselves admit they don't feel prepared to go out and work in a rural town.

 

I agree that it's a challenge to not have all the specialists to consult, but during the 5 years I don't know how much more you get ready for this, as my understanding is that you'll be working mainly in big academic centers and will therefore use these specialists every time you need them. I guess maybe there is some time to get rural emerg experience during the 5 yrs more than the +1, but I think another way to make that work might be to work in a mid-size emerg after the +1, where, say, you would be 2 docs working and therefore could consult each other when unsure...

[Franky83]

I agree that it's a challenge to not have all the specialists to consult, but during the 5 years I don't know how much more you get ready for this, as my understanding is that you'll be working mainly in big academic centers and will therefore use these specialists every time you need them.

 

One of the primary differences is that residents in the 5 year program spend more time on ICU, CCU, Neurosurgery, Orthopedics etc (the "consulting services"), than residents in the +1 program. Therefore, when they graduate, they have more experience in managing "sicker" patients and patients who you might otherwise want a consultation on.

 

Remember, both the CCFP and FRCP curriculums are not just emergency medicine all the time. You need to consider what rotations the residents will go through and how much time they spend on those rotations. Then ask yourself, would you feel comfortable with this amount of experience before you begin your independant practice.

 

In regards to the 5 year residents "using specialists every time they need them"; remember that, in general, the 2+1 residents and the 5 year residents train in the same facilities, with the same availability of consulting services.

[leviathan]

One of the primary differences is that residents in the 5 year program spend more time on ICU, CCU, Neurosurgery, Orthopedics etc (the "consulting services"), than residents in the +1 program. Therefore, when they graduate, they have more experience in managing "sicker" patients and patients who you might otherwise want a consultation on.

 

Remember, both the CCFP and FRCP curriculums are not just emergency medicine all the time. You need to consider what rotations the residents will go through and how much time they spend on those rotations. Then ask yourself, would you feel comfortable with this amount of experience before you begin your independant practice.

 

In regards to the 5 year residents "using specialists every time they need them"; remember that, in general, the 2+1 residents and the 5 year residents train in the same facilities, with the same availability of consulting services.

Someone told me the 5 year dudes in tertiary hospitals refer everything off to specialists and don't handle anything on their own, simply because they can and are maybe even obligated to do so for liability reasons. In community hospitals without so many consulting services, the ER docs deal with a lot more stuff on their own, whether they be 5 year or CCFP-EM trained, or just FPs.

[juicyprunes]

Something else to consider that I don't think has been mentioned (sorry, I haven't read through all the posts) is the career longevity and flexibility offered by the 2+1 program.

 

From I've heard and observed, many FRCPC ER docs start transitioning to alternate careers at around mid 40's to early 50s (e.g. administration, etc.), where as CCFPs can always go back to a family practice +/- another area of interest. Despite the relative lifestyle-friendliness of emerg, shift work is hard!!

[drpdotodot]

Something else to consider that I don't think has been mentioned (sorry, I haven't read through all the posts) is the career longevity and flexibility offered by the 2+1 program.

 

From I've heard and observed, many FRCPC ER docs start transitioning to alternate careers at around mid 40's to early 50s (e.g. administration, etc.), where as CCFPs can always go back to a family practice +/- another area of interest. Despite the relative lifestyle-friendliness of emerg, shift work is hard!!

 

With all due respect, I find it hard to imagine a CCFP EM doc who has worked in the Emerg full-time for 20+ years to make a smooth transition back to family practice afterward. I know of docs who do part-time ER and part-time FM (to keep up with skills in OBS, chronic disease management) - this makes sense.

 

I picked and will be starting the FRCPC program because I wanted to practice EM. The flexibility to sub-specialize in Peds ER, Critical Care, Toxicology, Anesthesia make it a more attractive program in my opinion.

When I am 55, I can always do Toxicology, teach, or maybe, just maybe, retire.

[Satsuma]

Someone told me the 5 year dudes in tertiary hospitals refer everything off to specialists and don't handle anything on their own, simply because they can and are maybe even obligated to do so for liability reasons. In community hospitals without so many consulting services, the ER docs deal with a lot more stuff on their own, whether they be 5 year or CCFP-EM trained, or just FPs.

 

And you 1) believed that ? and 2) thought it worthy of posting on a public forum?

[leviathan]

And you 1) believed that ? and 2) thought it worthy of posting on a public forum?

Yep. It makes perfect sense and it's pretty relevant to the discussion, thanks. For instance, in a tertiary hospital how quick does an ACS patient get admitted to the hospital and managed by an internist? From my experience the EPs usually only take care of them for a few hours before they get a bed. In community hospitals they often take them overnight until the internist shows up in the AM. I don't know why you find this offensive.

[drpdotodot]

Yep. It makes perfect sense and it's pretty relevant to the discussion, thanks. For instance, in a tertiary hospital how quick does an ACS patient get admitted to the hospital and managed by an internist? From my experience the EPs usually only take care of them for a few hours before they get a bed. In community hospitals they often take them overnight until the internist shows up in the AM. I don't know why you find this offensive.

 

I don't have tons of experience but I am pretty sure this is region specific. I've worked in tertiary centres where the EPs are quiet involved with the management of ACS pts, trauma pts, etc.

 

And I'm pretty sure that if you're doing the FRCPC residency at places where the EPs "refer everything off to specialists and don't handle anything on their own, simply because they can and are maybe even obligated to do so for liability reasons" - you would come out as a pretty passive, poorly trained FRCPC ER doc. This is not the case, anywhere.

 

The tertiary centres are here to train as well so maybe you're just not realizing that the residents do a chunk of the work for the staff?

 

Either way, its pretty fair to add your perspective to the conversation, I'm not offended.

[Satsuma]

Someone told me the 5 year dudes in tertiary hospitals refer everything off to specialists and don't handle anything on their own, simply because they can and are maybe even obligated to do so for liability reasons. In community hospitals without so many consulting services, the ER docs deal with a lot more stuff on their own, whether they be 5 year or CCFP-EM trained, or just FPs.

 

Maybe you should step back and read your post again. I have bolded the parts that are glaring inaccuracies. If after that, I need to explain why I take issue with that, then I wouldn`t even bother wasting my time explaining.

 

And even worse is that those comments don`t even come from your own experience. It comes from "someone". Find me some data that show 5 year ER docs refer everything to specialists and don`t handle anything on their own. You won`t find it...why? Because it isn`t true.

 

 

For instance, in a tertiary hospital how quick does an ACS patient get admitted to the hospital and managed by an internist? From my experience the EPs usually only take care of them for a few hours before they get a bed. In community hospitals they often take them overnight until the internist shows up in the AM.

 

Well ER docs - 5 year or not, anywhere aren't taking anyone to the cath lab, and so if you are referring then to NSTEMIs...you give them ASA, plavix, fonda/heparin, oxygen, a beta blocker some nitro and morphine for pain control. ER docs will do that everywhere and then call medicine for admission and further workup which could include cardiac echo, non-urgent cath etc over the next few days. Just because in a community hospital the pt sits in the ER all night, doesn`t imply the ER doc in the community is doing anything more. The pt in the tertiary centre just gets to spend the night on the medicine floor, and the ER doc gets to see another pt cause a bed is free.

[leviathan]

Maybe you should step back and read your post again. I have bolded the parts that are glaring inaccuracies. If after that, I need to explain why I take issue with that, then I wouldn`t even bother wasting my time explaining.

 

And even worse is that those comments don`t even come from your own experience. It comes from "someone". Find me some data that show 5 year ER docs refer everything to specialists and don`t handle anything on their own. You won`t find it...why? Because it isn`t true.

After reading back what I said, I can see how I came off sounding condescending to the training and competency of EPs, and I apologize. As a former paramedic who dealt with emerg docs on a regular basis, I have tremendous respect for them and that was not my intention of my post.I also know the crap they deal with every day from specialists who rag on them for things similar to what I said. However, that is usually an attack on ALL emerg docs. The intent of my post was not an attack on ANY EPs, rather it was just to illustrate an obvious difference between a community EP vs. an urban EP who works in a tertiary hospital with ample resources. It's obvious that one is forced by necessity to acquire more experience and responsibility in a rural or community setting where they don't have the same accessibility to consultants. The same is true about rural FPs vs. an FP who works at an urban walk-in clinic. I don't see how you can disagree with this or ask for data to prove it. It's not to say that one doctor is incompetent, they are both good at what they do for their own particular environments. If you threw a doc who works at a big hospital into a small one, they would end up taking on more responsibility too out of the same necessity.