4 ms·

The reimbursements for ER doctors are incredibly out of wack with the training and responsibilities compared to similar physicians, and especially with advanced

The reimbursements for ER doctors are incredibly out of wack with the training and responsibilities compared to similar physicians, and especially with advanced practice nurses/PAs. In some places, it's not uncommon to have ER docs making over $500k while the internal medicine docs that they turn their sickest patients over to will make less than half of that. The non-physician staff performing the same will see less still. Compared to the IM docs, they have the same educational requirements, same residency length, they work at the same hospitals, but the ER docs just rake it in.

seanmcdirmid 4y ago
Don’t ER docs have to work odd hours and see patients without any prep or background? I get the docs have the same education, but I can see taking half pay for a more predictable schedule and patient load, along with lots of time before hand to figure things out. They are different jobs, supply and demand probably sets one to be higher paid than the other.
- ghufran_syed 4y ago
  Right - and the risk is much greater seeing “unfiltered” emergency patients, compared to a patient who has had a full assessment in the ED, had surgical issues ruled out, etc and was then admitted to the internal medicine service.
  - mikeyouse 4y ago
    What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Last I looked, independent ER docs pay something like $15k more per year than IM docs for solo coverage... there's still quite a ways to go to make up that other quarter million dollars. I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... it's not "supply and demand" that's increasing ER salaries, it's a private equity cartel that aggressively upcodes routine treatment and then sues hospitals to increase their reimburesment rates. https://en.wikipedia.org/wiki/TeamHealth https://en.wikipedia.org/wiki/TeamHealth https://tennesseelookout.com/2022/05/09/tennessee-health-billing-firm-accused-in-court-of-cartel-like-behavior/ https://tennesseelookout.com/2022/05/09/tennessee-health-bil...
    - ghufran_syed 4y ago
      because besides money, maybe some human doctors find it emotionally difficult to tell someone their family member died because we made the wrong diagnosis, or took too long to make the correct diagnosis? By analogy, if you have home insurance, you don’t mind if your house burns down? Seems unlikely…
    - seanmcdirmid 4y ago
      > What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Stress isn't alleviated just by insurance. Sometimes people care about doing their job right and "winning". ER docs are just put on the spot constantly. > I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... It doesn't really matter, unless you want to claim that they employ more ER docs than the other systems put together, which I doubt they are even close to that. If Blackstone had a lock up on ER services, you would think they would not pay their ER docs as much to stick around since they would have fewer places else to go.
      - mikeyouse 4y ago
        The popular conception of an ER doc is completely divorced from the day-to-day reality.. This isn't House, they're not "put on the spot" constantly like they're on some island. They are part of a care team and they call for IM/ID/Cardio/Radiology consults when they have any question about a diagnosis. They certainly have stressful jobs but no moreso than the floor physicians or other providers who work the same shifts and who take the critically ill patients when they need care beyond the capabilities of the ER.
        seanmcdirmid 4y ago
        If being an ER doctor is such a cushy deal for more money, doctors who would otherwise choose internal medicine would just choose that. There is plenty of variation in medical specialties, but, at least for people who are going to medical school today, I'm sure they are well informed what is in demand and what isn't. At least in this case, I don't see non-market forces at work (whereas medicine has plenty of those in other places).

seanmcdirmid 4y ago

Don’t ER docs have to work odd hours and see patients without any prep or background? I get the docs have the same education, but I can see taking half pay for a more predictable schedule and patient load, along with lots of time before hand to figure things out. They are different jobs, supply and demand probably sets one to be higher paid than the other.

ghufran_syed 4y ago
Right - and the risk is much greater seeing “unfiltered” emergency patients, compared to a patient who has had a full assessment in the ED, had surgical issues ruled out, etc and was then admitted to the internal medicine service.
- mikeyouse 4y ago
  What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Last I looked, independent ER docs pay something like $15k more per year than IM docs for solo coverage... there's still quite a ways to go to make up that other quarter million dollars. I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... it's not "supply and demand" that's increasing ER salaries, it's a private equity cartel that aggressively upcodes routine treatment and then sues hospitals to increase their reimburesment rates. https://en.wikipedia.org/wiki/TeamHealth https://en.wikipedia.org/wiki/TeamHealth https://tennesseelookout.com/2022/05/09/tennessee-health-billing-firm-accused-in-court-of-cartel-like-behavior/ https://tennesseelookout.com/2022/05/09/tennessee-health-bil...
  - ghufran_syed 4y ago
    because besides money, maybe some human doctors find it emotionally difficult to tell someone their family member died because we made the wrong diagnosis, or took too long to make the correct diagnosis? By analogy, if you have home insurance, you don’t mind if your house burns down? Seems unlikely…
  - seanmcdirmid 4y ago
    > What risk? Malpractice coverage is provided by the hospital, or more typically, the private equity group that owns the ER physician practice. Stress isn't alleviated just by insurance. Sometimes people care about doing their job right and "winning". ER docs are just put on the spot constantly. > I don't think the average person realizes that Blackstone is one of the largest employers of ER docs... It doesn't really matter, unless you want to claim that they employ more ER docs than the other systems put together, which I doubt they are even close to that. If Blackstone had a lock up on ER services, you would think they would not pay their ER docs as much to stick around since they would have fewer places else to go.
    - mikeyouse 4y ago
      The popular conception of an ER doc is completely divorced from the day-to-day reality.. This isn't House, they're not "put on the spot" constantly like they're on some island. They are part of a care team and they call for IM/ID/Cardio/Radiology consults when they have any question about a diagnosis. They certainly have stressful jobs but no moreso than the floor physicians or other providers who work the same shifts and who take the critically ill patients when they need care beyond the capabilities of the ER.
      - seanmcdirmid 4y ago
        If being an ER doctor is such a cushy deal for more money, doctors who would otherwise choose internal medicine would just choose that. There is plenty of variation in medical specialties, but, at least for people who are going to medical school today, I'm sure they are well informed what is in demand and what isn't. At least in this case, I don't see non-market forces at work (whereas medicine has plenty of those in other places).