michaelm Posted February 2, 2012 Report Share Posted February 2, 2012 how much do ED docs actually make in BC and ON? is there a difference in CCFP (EM) vs FRCP ? how many hours a week do they usually work? Link to comment Share on other sites More sharing options...
ghost dog Posted February 2, 2012 Report Share Posted February 2, 2012 how much do ED docs actually make in BC and ON?is there a difference in CCFP (EM) vs FRCP ? how many hours a week do they usually work? Hard to say, but they do make pretty good coin. I don't believe there is a huge pay difference in regards to CCFP versus FRCP - but you may be somewhat limited in where you work ( i.e. academic downtown hospitals). But not much limitation. Most full time ER docs usually work 12 - 16 shifts / month ( 8 hour shifts). Link to comment Share on other sites More sharing options...
hking03 Posted February 2, 2012 Report Share Posted February 2, 2012 take this with a grain of salt as I'm a first year with no actual experience... however, I have looked into emerg a bit on my end. I have a feeling moo could also speak to this a bit and perhaps a search of the forum may give you some more info. Basically, In BC an EM doc who did the Royal College (5 yr) residency or the CCFP-EM (1 yr) residency will make the same amount per hour... the only difference is the bigger academic hospitals like Victoria and VGH will not hire CCFP-EM docs so you can't work at those centres. Like ghost dog mentioned the shifts typically run about 8 hrs, but I've heard of 10 and 12 hour shifts... I think it depends on the hospital, staff and your own sanity. From what I've read the typical week is approximately equal to 35 hours of work. So you could do 3 12 hour shifts, 4 8 or 9 hour shifts, 3 or 4 10 hour shifts... whatever the hospital routinely does. It's shift work so one week might be 12am-8am and the next might be 12pm-8pm... I believe the pay varies, but from what I've read it seems to hover around the 175/hr mark in BC... You don't have overhead, you don't have a pager so you do your job and you go home. The downside is you don't have vacation time, but from what I've heard, you just pick up extra shifts the weeks before and after your vacation to make up for it... To give you some rough numbers. If you were paid 175/hr 35 hrs/week 52 weeks per year (assuming you make up the 6-8 weeks of vacation by working an extra shift for 24 weeks ) you'd gross 318,500k... that's not accounting for overtime (if they get it) or anything else you might be doing. I don't know how sustainable that would be but it's a pretty nice chunk of change all things considered. Like I said, take it with a grain of salt, but that's what I have heard from EM docs in BC as well as research I've done on my end. Link to comment Share on other sites More sharing options...
justletmein Posted February 2, 2012 Report Share Posted February 2, 2012 It's shift work so one week might be 12am-8am and the next might be 12pm-8pm... Most emerg departments actually run the MD shifts just like nursing shifts, in other words: -8AM-4PM -4PM-12AM -12AM-8AM I have seen some departments also do 10AM-6PM shifts to have some overlap during busy periods. 12 hr shifts in my opinion are ridiculous, and I have very rarely seen EM docs working that many hours in a row. A 12 hr day in IM is not like a 12 hour day in the ER. Since I am a big fan of the CCFP-EM program I will mention that there is a VERY high burnout rate for EM docs even if their schedule sometimes seems like a breeze compared to other specialties. The ER can be gruelling and later in your career, the only way to "slow down" is to take less shifts. CCFP-EM docs have the luxury of modifying their practice to be more office-based and therefore much better quality of life (at least IMO). Link to comment Share on other sites More sharing options...
A-Stark Posted February 2, 2012 Report Share Posted February 2, 2012 That's not my experience, as nurses here seem to work exclusively 7-7. Emerg shifts are all over the place otherwise, and before Christmas I worked 0900-1700, 2130-0430, 0400-1100, 1530-0000, and it goes on. My last two shifts were 2200-0430 (except I left closer to 5:30) and 0400-1100. Suffice it to say that I was wiped in between and after them. Link to comment Share on other sites More sharing options...
moo Posted February 2, 2012 Report Share Posted February 2, 2012 Billing and shift work depend a lot on location. In rural hospitals, you can be "on-call" for an emerg for 24 hours straight. As a resident, I remember sleeping in the hospital and having nurses call me whenever a patient came in to the emerg. You'd see patients in emerg while you were in clinic during the day. In community and academic hospitals, you will be on shifts. There can be various shifts starting/ending at different times. Some hospitals do 7-3, 3-11, 11-7, with various staggering shifts. As for billing, it really varies from place to place. In rural hospitals, it's mostly FFS. In community hospitals, it can be FFS (the person who saw the patient first takes the billing) or you can get a set rate (say 200-300/hr) but you still have to do shadow billing so that the hospital actually gets paid (how much you get paid may depend on how busy the emerg was that month--so the more patients that are seen, the more money that goes into the pot and that gets divided up based on the number of hours worked). I'm not sure how it works for academic hospitals but I think it's a combination of shadow billing or salary. This probably varies from institution to institution. I also echo the fact that emerg docs can get burned out quite early in their careers. I've personally known 4 docs (3 are CCFP-EM, and 1 was FRCPC who retrained in FM) who did EM and who all burned out within a year or two and are now only doing clinic. (Part of it is also family reasons.) I personally thought about doing CCFP-EM for a while, but after doing emerg in residency, I really couldn't stand the work. But what I really couldn't stand was the shift work. And you're talking to someone who did shift work all throughout undergrad. In EM, the work is dead tiring and I always found it impossible to sleep the following morning because you were still so wired from the night before. 14-16 shifts a month doesn't sound like much but I found that after working one night shift, it usually would take me at least 2 days to recover (and you rarely just do one night shift, it's more like 4 in a row). Link to comment Share on other sites More sharing options...
mavrik13 Posted February 2, 2012 Report Share Posted February 2, 2012 In the Toronto teaching hospitals, they make ~$200/hr in EM. There is no 'overtime' (i.e. if you work past your shift time, you're working for free), and no 'time and a half/double time' for working stat holidays/overtime. No pay differential between CCFP-EM and FRCPC. You would be surprised at some CCFP-EM's working in large academic centres - I know a few in Halifax, and at least one in Vancouver. It's becoming more and more common. The lifestyle isn't bad, but quickly wears on you. This is a little off topic, but is there a reason they still run the FRCPC EM residency? Do they really gain that much more experience that it takes them an extra 2 years to complete residency? Why not eliminate it, and run a two year CCFP-EM residency instead? Link to comment Share on other sites More sharing options...
justletmein Posted February 2, 2012 Report Share Posted February 2, 2012 This is a little off topic, but is there a reason they still run the FRCPC EM residency? Do they really gain that much more experience that it takes them an extra 2 years to complete residency? Why not eliminate it, and run a two year CCFP-EM residency instead? The short answer is yes, they get MUCH more experience. Especially when working in large trauma centers I think a 5-year residency is a major asset. Link to comment Share on other sites More sharing options...
wheaties Posted February 3, 2012 Report Share Posted February 3, 2012 No idea what the pay structure is like but these guys are doing alright... http://www.winnipegfreepress.com/local/er-doctors-top-earners-wrha-report-shows-97460379.html http://www.winnipegfreepress.com/local/ruthless-mds-hogged-provincial-er-fund-letter-116386554.html Link to comment Share on other sites More sharing options...
moo Posted February 3, 2012 Report Share Posted February 3, 2012 Hard to say. Are they FFS? Are they salaried? If they're FFS it's easy to imagine how they can make that much. I highly doubt they will make that much on salary (with benefits, etc.). The CEO banking 400K is likely a salary, and I would take that any day over the 550K the emerg doc makes, assuming the emerg doc is on FFS. Link to comment Share on other sites More sharing options...
what Posted February 3, 2012 Report Share Posted February 3, 2012 MB is paid an hourly wage. most places outside of BC and AB are -- or at the very least, blended. in terms of pay, most places i've looked tend to be around the $200 per hour range. in NS and NB its about that. in ON i think it tends to be a bit less, around the $180 range but that varies as well. in SK, emerg docs can actually incorporate and put their salary into their corporation, which is pretty amazing. Link to comment Share on other sites More sharing options...
michaelm Posted February 4, 2012 Author Report Share Posted February 4, 2012 is it worth training for 5 years +/- fellowship to earn as much as a family doc? it appears that they make 30-40% less than fellowship trained internists, according to this thread at least. if thats the truth, why is it competitive? doesn't make much sense Link to comment Share on other sites More sharing options...
moo Posted February 4, 2012 Report Share Posted February 4, 2012 It's "prestigious" to tell people you're an emerg doc. It's cool to tell people you are only working 15 shifts a month. Most people don't realize the burnout and the disruption that shift work will cause until it's too late. But others thrive on it. Link to comment Share on other sites More sharing options...
Dany Posted February 5, 2012 Report Share Posted February 5, 2012 No idea what the pay structure is like but these guys are doing alright... http://www.winnipegfreepress.com/local/er-doctors-top-earners-wrha-report-shows-97460379.html http://www.winnipegfreepress.com/local/ruthless-mds-hogged-provincial-er-fund-letter-116386554.html ugh so a doc earns 500k... is it really worthwhile to be reported on the biggest local newspaper? It would if the income were 5 million, but 500k for a physician, although quite high, doesn't make a breaking news to me and i am still wondering why no radiologist/ophtho in Winnipeg region makes higher than that Link to comment Share on other sites More sharing options...
ghost dog Posted February 6, 2012 Report Share Posted February 6, 2012 It's "prestigious" to tell people you're an emerg doc. It's cool to tell people you are only working 15 shifts a month. Most people don't realize the burnout and the disruption that shift work will cause until it's too late. But others thrive on it. BUT, " most people " don't realize that 15 shifts a month is a lot for an ER doc, as this includes night shifts , weekends , holidays, etc. This sucks. Also, ER can suck in other ways: 1. Suturing screaming kids. 2. Drug seekers ( you get quite a few of these in the ER). 3. Drunken / drugged out idiots. 4. Frequent fliers ( see #3 ). 5. Shift work. The glamor of the ER is not what people think - you rarely get the ACLS " save " - those people usually die. The cases you found interesting in residency are either now run of the mill or a pain in the ass. Thus, the burnout rate that Moo has referred to. Link to comment Share on other sites More sharing options...
michaelm Posted February 6, 2012 Author Report Share Posted February 6, 2012 BUT, " most people " don't realize that 15 shifts a month is a lot for an ER doc, as this includes night shifts , weekends , holidays, etc. This sucks. Also, ER can suck in other ways: 1. Suturing screaming kids. 2. Drug seekers ( you get quite a few of these in the ER). 3. Drunken / drugged out idiots. 4. Frequent fliers ( see #3 ). 5. Shift work. The glamor of the ER is not what people think - you rarely get the ACLS " save " - those people usually die. The cases you found interesting in residency are either now run of the mill or a pain in the ass. Thus, the burnout rate that Moo has referred to. given this information, FRCP EM appears to be the absolute worst out of the other primary care specialties (FM, IM)...given the lifestyle which is worse, and pay.... then why...is it so much more competitive to get into an FRCP EM program these days? Link to comment Share on other sites More sharing options...
justletmein Posted February 6, 2012 Report Share Posted February 6, 2012 given this information, FRCP EM appears to be the absolute worst out of the other primary care specialties (FM, IM)...given the lifestyle which is worse, and pay.... then why...is it so much more competitive to get into an FRCP EM program these days? The CCFP-EM R-3 match is becoming as, if not more, competitive as the R-1 FRCP EM match. Link to comment Share on other sites More sharing options...
Lactic Folly Posted February 7, 2012 Report Share Posted February 7, 2012 To be fair, drug seekers visit FPs as well, and if they're not well enough to go home from the ER, who gets consulted for admission? Some tolerate/enjoy shift work much more than others. Link to comment Share on other sites More sharing options...
moo Posted February 7, 2012 Report Share Posted February 7, 2012 given this information, FRCP EM appears to be the absolute worst out of the other primary care specialties (FM, IM)...given the lifestyle which is worse, and pay.... then why...is it so much more competitive to get into an FRCP EM program these days? Because med students and even residents don't realize what the lifestyle of an emerg doc is like until it's too late. Look, some people thrive on emerg and love the being up all night, shift work lifestyle. Most people, though, hate it and would even rather stomach call. It's just, of all the people I come into contact with, emerg is the one speciality that jumps out at me as the one with the highest burnout rate and the one with the most number of people leaving after only a few years of practice. Some can continue on with it, but even a lot of CCFPEM docs eventually get tired and choose to do mostly clinic or other things (I know of a 5th doc who does cosmetic surgery/botox now mostly, after her CCFPEM). As for FRCPC docs, you have to retrain in something else if you want to leave. Which really sucks. Link to comment Share on other sites More sharing options...
michaelm Posted February 7, 2012 Author Report Share Posted February 7, 2012 Because med students and even residents don't realize what the lifestyle of an emerg doc is like until it's too late. Look, some people thrive on emerg and love the being up all night, shift work lifestyle. Most people, though, hate it and would even rather stomach call. It's just, of all the people I come into contact with, emerg is the one speciality that jumps out at me as the one with the highest burnout rate and the one with the most number of people leaving after only a few years of practice. Some can continue on with it, but even a lot of CCFPEM docs eventually get tired and choose to do mostly clinic or other things (I know of a 5th doc who does cosmetic surgery/botox now mostly, after her CCFPEM). As for FRCPC docs, you have to retrain in something else if you want to leave. Which really sucks. why would u have to retrain? you really have all the skills needed for general internal med or FM after a 5 year residency... so theoretically speaking you can do anything FM or IM can do if you decide to walk out Link to comment Share on other sites More sharing options...
rmorelan Posted February 7, 2012 Report Share Posted February 7, 2012 why would u have to retrain? you really have all the skills needed for general internal med or FM after a 5 year residency... so theoretically speaking you can do anything FM or IM can do if you decide to walk out You wouldn't be able to get the insurance you need for one. The won't extend it for things you are specifically expected to do. No hospital would hire you - although you could open your own clinic you would be extremely vulnerable. If you ever mess anything up the college not support you at all. Very bad idea Link to comment Share on other sites More sharing options...
michaelm Posted February 7, 2012 Author Report Share Posted February 7, 2012 You wouldn't be able to get the insurance you need for one. The won't extend it for things you are specifically expected to do. No hospital would hire you - although you could open your own clinic you would be extremely vulnerable. If you ever mess anything up the college not support you at all. Very bad idea how is a walk in clinic different in scope of practice from the general EM? i would think its about 30% of general community ED at most..in terms of "scope" Link to comment Share on other sites More sharing options...
ghost dog Posted February 7, 2012 Report Share Posted February 7, 2012 how is a walk in clinic different in scope of practice from the general EM? i would think its about 30% of general community ED at most..in terms of "scope" From what I understand of Ontario's regulations, an ER doc would have to undergo a change in scope of practice assessment. I did one for interventional chronic pain - this is a pain in the ass. However, it's doable. For an ER MD, this would likely involve hanging out with a Family doc for awhile, and then doing the above. Link to comment Share on other sites More sharing options...
moo Posted February 7, 2012 Report Share Posted February 7, 2012 how is a walk in clinic different in scope of practice from the general EM? i would think its about 30% of general community ED at most..in terms of "scope" THe final arbitrator in all things is the provincial College of Physicians and Surgeons. I'm not arguing with you whether an FRCPC trained doc is competent to practice as a family doc. But there are things that a family doc does that is different from an FRCPC trained doc. Yes, the flus, and colds, and cellulitis and what have you are similar. However, there's a lot of chronic disease management, long term management of mental health problems, etc. that an FRCPC trained doc just may not be exposed to in their training. And that probably is the rationale. Can an FRCPC trained EM doc do these things? Probably. But will the College allow it? Not unless you undertake retraining. I'm just telling you what the College tells us. If you disagree with this, I urge you to contact the local provincial College to let them know what you think. Link to comment Share on other sites More sharing options...
Satsuma Posted February 7, 2012 Report Share Posted February 7, 2012 Because med students and even residents don't realize what the lifestyle of an emerg doc is like until it's too late. Look, some people thrive on emerg and love the being up all night, shift work lifestyle. Most people, though, hate it and would even rather stomach call. It's just, of all the people I come into contact with, emerg is the one speciality that jumps out at me as the one with the highest burnout rate and the one with the most number of people leaving after only a few years of practice. Some can continue on with it, but even a lot of CCFPEM docs eventually get tired and choose to do mostly clinic or other things (I know of a 5th doc who does cosmetic surgery/botox now mostly, after her CCFPEM). As for FRCPC docs, you have to retrain in something else if you want to leave. Which really sucks. Supposedly, actual emerg trained ER docs don't have a higher burnout rate than other specialties. (in comparison to say the family doc doing emerg in some community). But I've never looked up the studies myself. Shift work is definitely alot harder than it seems on paper, or even rotating through. I find I'm ok with shifts until about the 3rd month it hits me. Definitely messes with your circadian rhythm more than call. Especially since on your overnight shifts you are still working full speed and not sleepilly doing admissions like on call. It does suck to have to retrain to get out of the lifestyle. Shift work does have it's pros though, even if it does come with cons. Link to comment Share on other sites More sharing options...
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