What’s an Emergency Physician Worth?

by Marc Haber, MD FAAEM

Vice President, Young Physicians Section

New England Patriot cornerback, Asante Samuel, is eligible for free agency this year.  He may even be signed by the time this is published.  hopes to receive a 10+ million dollar per annum salary.

This made me think, what is an emergency physician worth?  Although I am happily positioned in an academic group I joined out of residency, I frequently get come-ons from ED recruiters.  My Gmail inbox receives roughly two per day, and a few others are often filtered out.  A recent ad told me I could work in my area for roughly 25% more than I am already making.  That got me thinking, what is my true worth?

In the ED, I am a work horse.  I teach.  I produce.  I also volunteer my time to AAEM.  I don’t take sick days.  I enjoy working nights, though am blessed with very few, because my colleagues like them more.  I will always switch my schedule to help out others on the staff.  I remember Administrative Assistant’s Day (for my boss as well).  I do TV and radio interviews.  Heck, I am even the captain of our softball team, the DNRs!  I am not necessarily the best at everything I do, but I am certainly a Charlie Hustle.  I work hard to do the best that I can do.  I am a director’s dream.

Before my ego swells further, don’t forget that I was also the one to come home with grey matter on my shoes.  I am stubborn.  I haven’t yet fully learned the work strategy of professional appeasement.  I still get into battles over minute things.  I occasionally fight with nurses and consultants.  Furthermore, my wife is always right.  I am learning wisdom, but am not yet wise.

In sum, I have the shortcomings of youth, but this is overcome by my vigor and work ethic.  The majority of you are just like me, with many of the same attributes and flaws.  Unique in vivo yes, but very similar on paper.  So that makes me think, what are we all worth?

According to some recent salary data....  Well, sure, first year graduates earn just above $200,000 base compensation, but this is not true worth.  Yes, benefits typically add 20-50K more.  Yet again, this is not true worth.  True worth isn’t salary, despite what Asante will tell you.  Depending on whom you ask one’s true worth is variable.  To your insurance company, true worth may equal anticipated compensation.  To your family, however, true value is not as easy to calculate; it includes love, companionship and other intangibles.

Beyond salary, beyond benefits, beyond the love of our families, what is our worth to society?  This is quite theoretical and difficult to measure.

What if we just disappeared?  What if medical students stopped choosing emergency medicine?  Who would care for our patients?  Who would pick up the slack?  Certainly not those approaching retirement; they have paid their dues.  They realize that life is for living and is much too short to waste.  Even for those with a strong sense of moral obligation, at some point one must be “selfish” and choose family over work.  Mid-level providers - would they come to the rescue?  Sure, to some degree PAs and NPs do and will continue to work in our EDs.  As helpful as knowledgeable mid-level providers may be, they can’t alone fill this theoretical void.  Other physicians?  From where?  The busy hospitalist service?  Overwhelmed office practices?  Surgeons?  We have enough difficulty getting them to take a call due to their concerns of malpractice and low payments, let alone to work in our EDs.  In reality, there is no one who can take our place.  We are it. 

Our true worth?  Invaluable.

So then, this begs many questions.  The one most important to me is: If we are invaluable, then why have we been thus far unsuccessful in ensuring our future?  With each additional day, we are allowing others to control our future.  Every year we have legislators and administrators adding to our day to day grind.  Antibiotics within four hours.  Pain scales.  Now perhaps mandated HIV testing in the ED.  Some excellent ideas on paper, but of arguable value in reality.  Our hospital directors and politicians may listen to our complaints, but they often don’t hear them.  Our colleagues see our pain on a daily basis, but have their own problems.  We are being deluged, not only with patients, but also by questionable policies and mandates.  The increasing patient burden is a mixed blessing.  In a basic economic sense, we are producing more with less; therefore, we should see a financial windfall.  Yet, our quality of patient care and our own lives sometimes suffer.  Each of us has seen this, and we know it will only continue, if not worsen.

This is where we, the young physicians, full of youthful vigor and enthusiasm, can make a significant difference.  We can simply do our shifts and go home, hoping to withstand the flood, or we can work together, promote solutions and push for necessary changes.  We can join, participate and donate to the ED advocacy groups that promote our future.  We can bring more media exposure to our concerns.  We can push to get on hospital committees that affect change locally and national committees that affect change nationally.  We need each other’s support to promote the future of emergency medicine.  I hope you start by encouraging your colleagues who are not already members to join YPS and make their voices heard.