So, you’re a medical student in their third or fourth year and you’re considering an emergency medicine residency. Given that you’re reading this website you’re also a savvy person who wants to know what are the prospects after residency? You want to know if going into emergency medicine, beyond the obvious pace and lifestyle, makes economic sense for you. Hopefully after reading this, you’ll have a better sense!
Emergency medicine is very much unlike other medicine fields such as internal medicine or pediatrics. In internal medicine, pediatrics, and family medicine most doctors are either affiliated with a hospital (a Hospitalist) or have their own offices where they accept their own patients, bill insurance carriers, etc. These offices may also fall under larger groups as well but this seems to be the consistent method currently.
Some other specialties such as surgery, anesthesia, orthopedics, and obgyn tend to have groups that they work with (usually a group of a few doctors) or are on their own, similar to internal medicine, who also have admitting privileges at a hospital (or hospital system). Emergency medicine doctors are somewhat similar to these particular fields. Nearly all emergency medicine doctors will work for a group in one way or another and how they are designated with that group is an important factor.
The Group
As I said above, nearly all emergency medicine doctors after residency will work for a group. This group, which can range from small to very large, will then contract out with EDs to staff the ED. You can sometimes be contracted out with just one ED or with multiple. The size of groups and its benefits and disadvantages is a whole other article that will be written about elsewhere. The next important factor is how you actually work for the group.
Under the same umbrella is working at an academic center. All of the above and below still apply, but at an academic center you’ll have the responsibility of educating, monitoring, and mentoring residents. Lastly, another alternative is locums. As a locums physician, you’ll still work for a group but you’ll travel around working for different EDs (either in a region or throughout the country and beyond).
Employee versus Independent Contractor
Your designation with a group will be either as an employee or an independent contractor. We’ll explain more about the differences in another article but for now, here’s the gist. An employee designation means you’ll usually have benefits paid for by the company (health insurance, 401k, etc.) and the taxes will be taken out from each of your paychecks. As an independent contractor you usually get minimal to no benefits from the company (this varies greatly) and you’ll have to pay your own taxes (usually quarterly). This means you’ll have to set up your own health insurance and retirement plans but it opens up a bevy of deductions you can make for your job (more to come on that later on).
So How Am I Actually Paid?
Most groups contract out with EM physicians on an hourly basis. Usually you’ll be offered X amount of money per hour and they’ll have an expectation for hours worked depending if you’re signing on as full time, part time, or a per diem basis. Some groups will offer incentives, such as sign on bonuses, while others may offer what’s called RVU’s or Relative Value Units. These RVUs, which we’ll describe more in depth later on, are essentially additional money you can earn based on your billing and coding.
This article should be a good primer on what to expect as an attending physician coming out of an EM residency. We hope it helps!
Dr. Melamed MD MPH
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