Like most of you, when I chose to pursue residency training in emergency medicine 17 years ago, I was motivated primarily by my interest in diagnosing and treating acute medical issues. I wanted to be there to help on the worst day of people’s lives and be one of the white knights of medicine who would take care of anyone, anywhere, anytime. It was a place where my “unique set of skills” (often derided as ADHD or a thirst for adrenaline) was an attribute, not a liability. The last thing I ever wanted was a job where I knew what I would be doing all day long before I ever pulled out of the driveway. Like most medical students, I didn’t pay nearly enough attention to the future income prospects and lifestyle associated with my specialty choice. Here's how much ER doctors make and six financial advantages emergency physicians enjoy.
ER Doctor Salary 2022
According to the Medscape's 2021 Physician Compensation Report the average salary of an Emergency Room Doctor is $354,000.
6 Financial Advantages of Emergency Physicians
#1 Emergency physicians have one of the highest hourly rates in medicine.
While emergency medicine generally shows up somewhere in the middle on salary surveys of the various medical specialties, what is not taken into account is the number of hours worked. While many specialists make more money than we do, they also work two or even three times as many hours to earn that money. On an hourly basis, our compensation is at or near the top of the list.
This can be easily demonstrated by comparing surveys of hours worked among the various specialties to salary surveys. In the 2018 Medscape Physician Compensation Report, emergency medicine was ranked 13th of 29 specialties, with an average income of $350,000. However, if you look at hours worked for the 12 highest-paying specialties using a 2011 Journal of the American Medical Association study, you will see those specialists worked an average of 216 to 1,183 more hours per year than the average emergency physician. Emergency physicians generally earn a total compensation of more than $200 per hour and sometimes more than $300 per hour.
#2 Most emergency medicine training programs are three years long.
The length of training for most specialties is longer, sometimes much longer. If you consider the other specialties that train for only three years (ie, family practice, internal medicine, and pediatrics), all of them are paid less than emergency physicians, both on an hourly and an annual basis. In fact, a typical community emergency physician makes more than many specialists who trained for four to six years!
This opportunity to begin earning an income earlier in our careers decreases the total size of our student loan burdens and allows our savings to begin compounding earlier. Our hourly rate per year of training is so much higher than all of the other specialties that it might even make up for all of those shifts when you don’t have time to eat, drink, or use the restroom.
#3 Our pathway to our peak level of earnings is very rapid.
In most careers, even within medicine, it can take decades to reach your peak earning potential. Not so in emergency medicine, where we usually reach peak earnings within two years of graduation from residency, even in a group with a sweat-equity buy-in. ln fact, due to a willingness to work more shifts and more undesirable shifts, young emergency physicians often make more than their older colleagues. Early peak earnings, especially when combined with financial literacy and discipline, help us to “take care of business” early on in our careers, paying off our student loans and mortgages and rapidly building a retirement nest egg.
#4 More so than most specialties in the house of medicine, we are an interchangeable cog in the machine.
While this has its downsides, such as the risk of small physician-owned groups being replaced by larger groups, the rare skill set of the competent board-certified, residency-trained emergency physician ensures the doc will only be without work for as long as it takes to get emergency credentialing (and perhaps a new state license). We have the ability to adjust very rapidly to a new department, even in the age of the electronic medical record. While no one job is all that secure, our ability to find a high-paying job somewhere is fairly certain.
#5 One of the biggest downsides of emergency medicine is that it really isn’t a “lifestyle” specialty.
Only about a quarter of emergency physician shifts are worked during banker’s hours. The rest are worked in the evening, at night, on weekends, and on holidays. However, this setup allows for a very unique opportunity; we have a lot of time off during regular business hours. While many emergency physicians use this time to recover for their next shift, take care of family responsibilities, engage in academic activities, and pursue hobbies (ski slopes, mountain bike trails, and lakes always seem deserted on weekday mornings), we also have the opportunity to engage in entrepreneurial pursuits.
It is tough to start and run a business entirely on weekends and in the evenings, but it is relatively easy to do so during the day and then practice medicine in the evenings when most ED shifts are worked. Time off during the day also allows us to be able to competently care for our own investment portfolios and rental properties, saving thousands in advisory and management fees. By late career, many physicians are paying a month’s salary each year just for investment management simply because they do not have the time that we have.
#6 The flexibility of shift work provides for numerous burnout-reducing measures to be taken.
While emergency medicine is traditionally ranked high on the percentage of doctors with burnout symptoms, when the severity of an individual’s burnout is measured, we actually rank fairly low. In few other specialties is it as easy to cut back to three-quarter time or half-time to go on the “parenting track,” do medical missionary work, or take a sabbatical.
Some groups have found innovative ways to reduce the effect of burnout-inducing night shifts on the group. Hiring a couple of nocturnists (and paying them well) can dramatically reduce shift-work sleep disorder. Innovative groups come up with solutions to ensure nobody is working shifts they do not wish to work.
In my group, we have a large shift differential between day, evening, and night shifts. We simply let “the market” decide what each shift is worth. For us, it turns out a night shift is worth about 50 percent more than a day shift. The younger docs with high student loan burdens and new mortgages often volunteer to work all or mostly nights, and the older docs with fewer financial worries tend to work the day and evening shifts. If more docs start wanting to work day (or night) shifts, we simply adjust the differential until everybody is working exactly the shifts they want and being paid accordingly. This common-sense solution boosts career satisfaction, increases longevity, and builds a collegial sense of teamwork in the group.
Emergency medicine has significant financial advantages over other specialties. Take advantage in order to improve your career and financial situation.
What do you think? What other specialties have significant financial advantages? How much did finances affect your specialty choice? Comment below!
I like your point about the actual hourly rate as well as the training time difference that certainly puts ER docs up there financially.
Radiology is a 5 year program so those 2 extra years can certainly create a lot of headwind financially compared to those shorter training programs. I feel shift specialties like Anesthesiology, Radiology, and ER have a lot of benefits in common as you can cut back easier and help prevent burnout.
Though technically radiology is a 5 year residency, nearly all residents will go on to do a one year fellowship. It wasn’t always like this, but this is the new standard for radiology trainees. And considering radiology residents take the major component of their boards at the end of their third year of radiology residency (pgy-4), and the last year of residency is designed mostly as an elective year, the benefit of a one year fellowship after residency can seem a little dubious. But that’s the expectation now, and most private groups and certainly all academic groups are going to expect a fellowship in something.
But you are right, the shift-like nature of radiology does allow for some flexibility in creating a schedule thats more lifestyle oriented. You definitely won’t be making as much as the regular radiologist gridding out an 8-5 workday and doing the late weekday shifts, weekend shifts and occasional night shifts, but flexible work arrangements can be found in the current market.
I also think there are huge 1099 “flexibilities” that are offered as an EM Doc that change how your retirement portfolio looks.
i401k is just one example.
It’s the ultimate “side gig” job and predominantly a 1099 position. While some still have “benefits,” it’s nicer in my opinion to allow more flexibility.
Benefits can make a large difference.
At the community mental health center where I work, they have a 100% match for my 5% of salary 401A contribution. At $15,000 a year (vests 100% at 6 years), this adds a nice chunk of $90,000 tax deferred growing money across six years.
On an hourly basis, my wage is salary/2080. This is because it’s a 40 hour week, and actually is only 40 hours per week. I’ve worked at other places where it was up to 60+ hours per week (but no extra $ for the “extra” 20 hours work).
In addition, the place has a 457 plan which allows about $25,000 off the top in addition to the 401A. This saves $5000 off my taxes (assumes 20% effective rate).
These three benefits (401A match, NOT working 60 hours for 40 hours pay, and access to a 457 plan) add up to quite a chunk. The “extra” half time job that some work for free is worth half a years salary of say $150,000 for a doctor, and the other two are worth $20,000 more.
So, my hourly wage is not the whole story. In addition, with 30 days of paid vacation and 11 paid holidays, and a week of paid time for CME, I don’t work those 48 days. That’s almost ten business weeks. At some jobs, I’ve had only three weeks off and 6 holidays.
On my side money made possible due to the regular job being only 40 hours, no call, no weekends, I can sell as many weekends and holidays as I want for up to $300 per hour.
So Psychiatry may not pay $300 per hour most of the time, but some “all outpatient” jobs allow one to ramp up the $$ by doing 1099 work on the side on weekends and holidays, and some jobs have unique benefits that ramp up the “hourly wage”.
The plethora of Moonlighting opportunities in psychiatry offer anyone willing to sell some of their freedom a way to increase their wage by half again their usual salary.
I do think that ER is very good in terms of being able to make a solid wage per hour, do defined shifts, and take the skills to a variety of settings including abroad.
You really get 30 days PTO? For new grads I heard that 19 days PTO was normal. I get the 11 days vacation paid and 5 days CME but my PTO days is far below 30. Mine goes to 25 days PTO if I stay several years.
You get what you negotiate. There is no standard or normal.
Yes, twenty days is common for docs to start. Usually this goes up a day or two per year.
At another job, I hit the max of 33 days after about 7 years.
At my current job, and the one prior, I simply asked for 30 days as part of the deal. There are so few psychiatrists around, the employers are happy to get one who can do the work and cause no problems.
The funny thing about outpatient Psychiatry PTO…you tend to see extra patients the 2 weeks before and after, which partly mitigates the cost.
For the non financially minded person having your peak salary so early in your career could be detrimental. If you expand your lifestyle to this early elevated salary you can put yourself in a real pickle. All the more reason to become financially literate as early as possible.
Excellent point about shift opportunities. This lets you control your total hours, PROVIDED, the field accepts the practice. In many specialties, even those that could in principle support flexible shift work, the norm is for everyone to be full time. High compensation practices often want very large total hours from each person. It seems that Emergency Medicine accepts this. Perhaps because the 24/7 nature of it forces too much shift work for any other approach to survive.
There are occasional posts here from EM docs who make huge incomes by working lots of hours and undesirable shifts. Some people can tolerate that long term without burnout. Still, I don’t know that they make as much as spine surgeons or cardiac surgeons working the same hours…
I would think that office practice derm would permit a lot of control over hours and very high income if one wanted to do long days and have lots of regular weekend appointments.
In addition, happiness surveys routinely rate dermatologists near the top. Agree that no emergency doc can tolerate working enough ED shifts to earn like a spine surgeon for long.
You forgot to mention the training of ER residents can be distilled into learning what radiological studies to order and how to intubate. Then as an attending it becomes even easier, order radiological studies to decide whether to admit, discharge or transfer out. Call respiratory to intubate. Oh I forgot to mention send in PAs and nurses to see patients so you don’t have to. It’s a snap.
Yea, I’ve been hearing that since I was an MS3. Of course, a similar paragraph can be written about every specialty pretty easily.
I would be terrified to do EM. The obvious emergencies at least you know how to respond. But most of the time you are trying to figure out which of the patients in the Department are acutely ill and which you can send home. Every one who does not get a million dollar workup could turn out to have something fatal.
Yeah, like walking across a mine field without a mine sweeper… You just have to get used to this risk, otherwise you’ll never have a restful night. :))
I agree that EM used to have many financial advantages but how long do you think this is going to last? There are so many new residencies popping up every year and the number of CMGs is constantly rising. I am really interested in EM but all these make me believe that the future of EM is bleak.
Yes, but so many emergency docs are also going part-time or retiring early. Maybe that’ll counteract it. If you love EM though, is it really a big deal if it pays 10-20% less? It would still beat half the specialties out there. Hardly bleak. There are still many EDs that are staffed by non-residency trained physicians.