mavrik13 Posted May 3, 2015 Report Share Posted May 3, 2015 It varies by centre, but the large centres I am aware of generally do a per-hour or per-shift billing rate. The guesstimates I have been told are in the range of about $180-200/hour. It is certainly not anything to turn your nose up to - most ERP's work 4 shifts per week. That ends up being under 300k, but some will work extra shifts (or fewer shifts). It certainly is good income, but comes at a price - irregular hours, often frustrating work environment, being looked down upon by consultants. You don't see many 'old' emerg docs, many of them get burnt out due to the nature of the work. As a specialty, it does have many perks. I think it has become a lot more popular because of the lifestyle (and job availability) - it seems appealing to only have to work 32-40 hours. Link to comment Share on other sites More sharing options...
rmorelan Posted May 3, 2015 Report Share Posted May 3, 2015 It varies by centre, but the large centres I am aware of generally do a per-hour or per-shift billing rate. The guesstimates I have been told are in the range of about $180-200/hour. It is certainly not anything to turn your nose up to - most ERP's work 4 shifts per week. That ends up being under 300k, but some will work extra shifts (or fewer shifts). It certainly is good income, but comes at a price - irregular hours, often frustrating work environment, being looked down upon by consultants. You don't see many 'old' emerg docs, many of them get burnt out due to the nature of the work. As a specialty, it does have many perks. I think it has become a lot more popular because of the lifestyle (and job availability) - it seems appealing to only have to work 32-40 hours. yeah 16-18 shifts a month is considered a full load - roughly 4 shifts a week as you say Shift work and the irregular hours can be exhausting - there have been some pretty major improvements though over the years as people have learned more about the impact etc. Less likely to be doing a 11pm-7am shift for instance now than in the past (centre dependent). In terms of raw hours - that is a lot less than most do. Per hour pay it is actually very good, and simpler in many ways further reducing the "hidden hours" other fields have in managing their business etc. Link to comment Share on other sites More sharing options...
frozenarbitor Posted May 10, 2015 Report Share Posted May 10, 2015 http://blog.essentialsofem.com/2015/05/05/eem-2014-top-10-video-countdown-1-why-we-do-em/ A great presentation by Dr. Mel Herbert on why we do emergency medicine. This specialty is awesome. Link to comment Share on other sites More sharing options...
hkmedic Posted May 12, 2015 Report Share Posted May 12, 2015 well at least they have the trump card - immediately patient needs. Not sure if my institution is special but they basically can get any test they want, no one can refuse a consult and once consulted that service is immediately the team now responsible for that patient (even if it doesn't make a lot of sense - although that team can then ask for a transfer to another team). The gov has prioritized emerg wait times, so the hospital has prioritized the emerg. The government tries to prioritize emerg, but in emerg, we have to fight with consultants unwilling to admit... Bed lock, admitted patients waiting in emerg for several hours before going up to the wards... And that stems from the top... So it's a different type of politics as A-Stark mentionned. Link to comment Share on other sites More sharing options...
rmorelan Posted May 12, 2015 Report Share Posted May 12, 2015 The government tries to prioritize emerg, but in emerg, we have to fight with consultants unwilling to admit... Bed lock, admitted patients waiting in emerg for several hours before going up to the wards... And that stems from the top... So it's a different type of politics as A-Stark mentionned. yeah - I mean obviously I know Ottawa emerg the best now - here like I said it is hard to push back against them (not that you usually should). It is just your patient pretty much as soon as they ask. You cannot refuse the consult. patient locked in emerg still happens - there just aren't enough beds. Link to comment Share on other sites More sharing options...
NLengr Posted May 13, 2015 Report Share Posted May 13, 2015 Fortunately at my institution the MRP remains the ERP until a patient is admitted. And we can refuse consults. Which is actually much more sensible than having the consultant assume care before they have even seen the patient. That system makes no sense, except that it lets you tell the government that patients are "out of the emergency room" (complete lie) in a shorter amount of time. In a province that pay bonuses for shorter ER stays, that can add up to some serious financial extras. The ER - consultant balance is a tricky one. On one hand, if you have a center where consultants are able to completely overpower the ER staff then you can get into the situation where people aren't getting admitted or seen when they need to be. On the other hand, if the ER staff hold too much power, you get problems with inappropriate consults and ER docs doing a half ass job with patients they see. The problem with most people on this board is the majority of us work in academic centers. In my experience the relationship between community consultants and ER docs is better than the one in academia. Link to comment Share on other sites More sharing options...
rmorelan Posted May 13, 2015 Report Share Posted May 13, 2015 Which is actually much more sensible than having the consultant assume care before they have even seen the patient. That system makes no sense, except that it lets you tell the government that patients are "out of the emergency room" (complete lie) in a shorter amount of time. In a province that pay bonuses for shorter ER stays, that can add up to some serious financial extras. The ER - consultant balance is a tricky one. On one hand, if you have a center where consultants are able to completely overpower the ER staff then you can get into the situation where people aren't getting admitted or seen when they need to be. On the other hand, if the ER staff hold too much power, you get problems with inappropriate consults and ER docs doing a half ass job with patients they see. The problem with most people on this board is the majority of us work in academic centers. In my experience the relationship between community consultants and ER docs is better than the one in academia. makes sense community would be better - staff to staff effectively, and people have looonnnggg memories. we do have problems with incorrect consults - ha, for cardiology we call that a case of troponinitis (anyone with elevated troponin regardless of how slight the increase gets a call to cardiology. 95%+ of that time it is just demand ischemia). Link to comment Share on other sites More sharing options...
ploughboy Posted May 14, 2015 Report Share Posted May 14, 2015 Random comments - 16-18 shifts a month is over a full line, close to a line and a half. That's approaching burn-out territory. 12-14 shifts a month is typical - I'm not sure where this figure of $200k /yr for a full-time ER doc is coming from. I've already said it, but to re-emphasize: this number is incorrect. - the dynamic between ER and consultants is very different in the community vs in the ivory tower. In academic centres you have house-staff available 24/7, so the poor GSx intern has to schlep down to the ER at 4AM to admit a stable appendicitis. In the community that gets held over to the morning, or gets admitted to the GSx ward with the ER doc remaining MRP until the sun comes up. The on-call surgeon gets a phone call in the morning ("I admitted an appy to your service, he's fine, here's his name and MRN") and life goes on. - "one-way" consults are double-edged. There absolutely are ER staff who abuse this ("hi cardiology, I've got a patient with chest pain down here I need you to see..." Diagnosis based on 5 minutes of history and a quick chest xray turns out to be lung cancer, but now he's cardio's problem until he can be pawned off on medicine). They embarrass the rest of us - we don't like that behaviour either because it reflects badly on us as a group. On the flip side, I've heard horror stories from a large academic centre somewhere east of the Ottawa River and west of the Atlantic Ocean where the oncoming ER doc inherits a department where there are 10 or 20 patients who obviously need to be hospitalized but who haven't been dispo'd yet because of bed politics. - "several hours" to go up to the wards - heck, I just intermittently bi-pap'd an old lady for 2 days in the ER before I could get her into step-down because there were no beds. It's a patient safety issue, because downstairs they're nursed between 1:4-1:6 instead of 1:2, and it's usually absolute chaos in the ED. So frustrating! Rant over. Link to comment Share on other sites More sharing options...
Maruo Posted June 4, 2015 Report Share Posted June 4, 2015 So that ~200k value (which I think I've seen somewhere as well) is skewed by all of the ER docs that work fewer hours (and thus make less)? Link to comment Share on other sites More sharing options...
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