How are Emergency Department Doctors Employed?

Hey Suzy, how are Emergency Department doctors employed?

As most of you know EM (Emergency Medicine) is a specialty just like cardiology or surgery. The main difference is that most other specialist have an office practice and admit patients to the hospital. EM does not (except in rare instances in mostly remote areas) admit patients to the hospital. EM does episodic care in the ED (emergency department) they have no office to see patients.

Independent / “Democratic” Group: This is a group of physicians that contract with the hospital to provide physician coverage in the ED. They are not paid by the hospital and contract their billing and billing services. These physicians usually work fee-for-service which means they "eat what they kill" so to speak. This “at risk” model necessitates that their pay is dependent upon seeing patients efficiently and documenting in a comprehensive manner for revenue and liability purposes. In geographically disadvantaged or smaller sites (usually less than 22,000 patients annually) they may also get a "stipend" from the hospital because economic factors and/or volume will not allow the reimbursement to pay a competitive wage to provide services. Absent this stipend the ED physicians would probably seek out a more favorable work environment.

Corporate Physician Group: These include groups like TeamHealth, EmCare, Schumacher Group, Questcare, Keystone, GHEP, etc. These management groups contract with hospitals to staff their ED and employ the doctors that work in the ED's. They provide administrative and management services for the doctors. The doctors can be paid either a straight salary or more frequently they will have an incentive plan that bonuses them based on their productivity.

Hospital Employee: These ED physicians are employed by the hospital. They are paid by the hospital and may or may not have an incentive plan. They are more aligned with the hospital because of their employment status. This status frequently requires relinquishing some of the autonomy associated with private practice. This model is seen most frequently in the Northeastern U.S.

University Faculty: These physicians are faculty at the university and provide coverage as well as supervise residents caring for patients at the university hospital ED. These academic types tend to be mostly straight salary with the exception of a few business savvy university practices implementing a physician incentive plan. Physicians in other ED practice models can also supervise residents, and not all physicians working at university hospitals are necessarily employed by the university (i.e. they may be an independent group or a corporate group contracted to staff the ED).

Now you know the rest of the story...