Q. It seems that fewer emergency physicians own their own groups. What can I do to increase my income and financial security?

A. The percentage of emergency physicians who are partners in small democratic groups decreases each year, and it’s easy to understand why. Not having to worry about “business stuff” is attractive to many doctors. The growing debt burden for new residency graduates has increased the need for higher initial salaries—perhaps at the cost of lower long-term income. That means that coming up with a financial, or “sweat equity,” buy-in for a heavily indebted graduate could also be difficult, especially with the prospect of a small democratic group becoming part of a contract management group (CMG) before the investment could be recouped. In addition, there are now so few small democratic groups that many doctors interested in that model no longer have the option in their desired geographic areas and are faced with the likelihood of being an employee for their entire career.

This puts numerous emergency physicians in the same position that many employees in corporate America have been in for some time. Loyalty to “the company” isn’t rewarded in the same way it might have been decades ago. Employees are unlikely to stay in the same location, working for the same employer for their entire career, and then retire with a pension and health care provided by the company.

Your job as the CEO of You Inc. is to get as much as you can in exchange for your work and value.

If a small democratic group isn’t in your future, you still stand the best chance to be successful if you think of yourself as an owner: the owner of “You Incorporated.” Just like any business owner, you have revenue and expenses. From time to time, you’ll negotiate contracts that will increase revenue. And as the chief financial officer of You Inc., you’re in charge of reducing expenditures. Taking this attitude should change the way you approach your personal finances.

USE FLEXIBILITY TO YOUR ADVANTAGE

Partially driven by the rapid increase in both investor- and hospital-owned freestanding emergency departments, the number of emergency departments and ED patient visits in the country is increasing at a rate much higher than the increase in emergency physicians coming out of residency. Even before this trend, there were many emergency departments in the country that weren’t yet staffed by residency-trained, board-certified emergency physicians. Demand is much higher than supply, and this can work to your advantage.