Q. How are finances different for emergency physicians compared to other specialties?

A. I am looking forward to seeing many of you this October at ACEP19, where I will be speaking about personal finance for the early-career emergency physician. As I reflected on this opportunity to engage with so many emergency physicians, l began to think about all of the financial advantages we enjoy compared to our colleagues in other specialties.

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. Today, I would like to review six financial advantages emergency physicians enjoy.

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 our 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.