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Emergency Medicine News:
doi: 10.1097/01.EEM.0000294653.98231.de
Career Source: Part 2 in a Two-Part Series

Not Spots: The 2006–2007 Job Market

Katz, Barbara

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Ms. Katz is the president of the Katz Company, an emergency medicine consulting firm dedicated to providing expert physician recruitment services and training emergency medicine residents in effective job searching.

While Texas, Florida, and Ohio will be the hot spots for emergency medicine jobs in the next year, certain regions of the U.S. particularly the Northeast, the Southwest, and the Pacific Northwest will provide only 12 percent of the jobs for graduating residents and other job seekers. Here's the breakdown.

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The Northeast

Covering seven states, the northeastern marketplace will provide only seven percent of U.S. jobs and is dominated by one, New York, with 60 percent of the region's employment opportunities. Jobs will be available in New York City's boroughs, except Manhattan, and in Syracuse and Rochester. The bulk of the openings will be in the upstate region with 43 percent coming from direct hospital employers and 34 percent with democratic groups.

Less than 10 percent of the state's positions will be open to primary care physicians, and national contract groups represent less than 25 percent of the market in New York. Connecticut and Massachusetts will have a smattering of opportunities throughout both states, with only an academic spot or two in Boston.

Rhode Island will have a few jobs but probably only one or two located in Providence. New Hampshire and Vermont are practically off the radar, but Maine looks to have a healthy season all around the state. The region also stands out as the only one that completely shuts out primary care physicians in all states (except for a few rural spots in New York) with the lowest percentage of national contract groups.

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Southwest, Pacific Northwest

Together, these two regions covering eight states will provide only 4.5 percent of the country's jobs for emergency physicians. Look for Arizona to top the Southwest with 90 percent of the jobs, including a few in Phoenix. National contract groups like TeamHealth West and EmCare will provide about 60 percent of the state's jobs and more than 40 percent will be open to primary care physicians.

Colorado will have the same two job openings it has every year: Pueblo and Colorado Springs. Utah, once again, is “Death Valley” for emergency medicine job opportunities. Washington state tops the Pacific Northwest with 50 percent of the jobs, with 87 percent coming from national contract groups and just under 50 percent in rural areas.

Eastern and central Wyoming will have some job opportunities, as will Oregon (mostly coastal), also predominantly through national contract groups. Both Idaho and Montana barely show up with a rural spot or two, once again, through national contract groups, and mostly open to primary care physicians as well. If you are squarely set on relocating to the Southwest, don't forget about the wonderful opportunities available through the Indian Health Service.

The annual When Pigs Fly Award for the least likely area for job opportunity goes to the entire state of Utah, despite rumors of a private group recruiting near Provo. Even if that were true, it's gone by now.

If you are determined to seek positions in low-opportunity areas, remember that a number of openings will manage to fly under the radar and will never be advertised. These positions are found by word-of-mouth from friends, colleagues, and faculty. Contact everyone you know who could provide this kind of valuable assistance, and be prepared to wait.

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Income Potential Report

It looks like the potential for higher incomes for new physicians will be in Georgia, Texas, North Carolina, Illinois, Wisconsin, Virginia, West Virginia, and Kentucky. In most cases, the package includes an incentive bonus. Some of the more notable compensation packages I saw included $1 million for three years in Kentucky, $200 an hour in southeastern North Carolina and southwestern Georgia, $190 an hour in Texas, $350,000 packages in Wisconsin, Minneapolis, and Ohio, and $340,000 packages in Virginia, Georgia, and West Virginia. I also found some pretty significant sign-on bonuses (up to $50,000) in hard-to-attract areas like West Virginia, as well as loan forgiveness of $50,000 per year in some rural hospital practices in the Midwest.

The following regional income data are based on 1,728 clinical hours per year, and includes incentive bonuses and basic benefits (if applicable) but no malpractice premiums. The numbers reflect all manner of private groups, hospital-based employers, and national contract groups but not partnership income because these packages are for newly hired physicians. They also don't reflect the occasional exceptionally high fee-for-service income module. These are nearly impossible to track because they are very rare jobs that fly under the radar and are not advertised or reported.

In the Northeast, look for an income low of $194,000 and a high of $250,000 with the average package based on $120 an hour, around $210,000. These salaries are most prevalent in New York, Connecticut, and Massachusetts. Incomes will be slightly lower in Maine and Rhode Island (though some groups will be offering good money) and lowest in New Hampshire and Vermont.

The Middle Atlantic states will see average packages of $200,000 a year, but the highest incomes will be found in Virginia, with a high hourly rate of $160, a high annual salary of $340,000, and an average annual package of $260,000. New Jersey will provide an average package of $240,000, as will the more urban areas of Maryland, but Pennsylvania appears to be all over the place. The high in the Keystone state will be about $300,000 around Pittsburgh and the low will be $170,000 in the more rural, central part of the state. Annual Pennsylvania averages will be $200,000.

The only figures I could get for the Southwest were in Arizona, including a group offering $150 an hour plus profit-sharing, a large contract group offering $140 an hour plus benefits, and a Phoenix opportunity paying $120 an hour plus malpractice and minimal health benefits. Because there are no major job opportunities looming in either Colorado or Utah, this will have to suffice.

If you are headed west, look for the biggest dollars to be in Texas. The Texas high is around $190 an hour ($350,000 package), and the average is about $150 an hour, providing an annual package of about $280,000. I did find a spot in the Dallas/Ft. Worth area offering a $70 night differential on top of a base of $150 an hour.

Oklahoma and Nevada will average about $130 per hour for a package of about $250,000. California also will have a wide range this year, with lows in rural areas of about $172,000 and highs in urban areas of about $240,000, with a statewide average of $210,000 annually. I'll say only this about the Pacific Northwest: If you are looking for incomes higher than $250,000, the best place to find them is around Portland, but don't look for ads. It's who you know, not what you see.

In the Southeast, salaries range from a low of $130 an hour in South Carolina to a high of $185 per hour in North Carolina. Average packages in North Carolina and Mississippi are in the area of $240,000, with South Carolina just a bit lower. Arkansas will have a high of $300,000 annually and a low of $215,000 in a more rural practice. Georgia will feature an average of $259,000 with scattered spikes as high as $330,000. Look for average hourly rates in Tennessee at the $140 to $150 level, and the few jobs in Louisiana will offer between $135 and $165 per hour. Florida will present with its usual ranges as wide as the Everglades: $130 to $170 per hour depending on location and employee status. There are seriously big bucks to be had in West Virginia at an average of $280,000 and a high of $350,000, with sign-on bonuses from $25,000 to $50,000.

All the “M” states will be running parallel in the Midwest with an average annual package of $220,000, though an occasional high could be about $290,000. The Dakotas are difficult to predict, but I did find one $200,000 package. The region's highest paying state looks like Wisconsin with an average package of $280,000 and a few annual incomes nearing $350,000. Look for average annual packages in the $230,000 to $240,000 range in Nebraska and Indiana, with some bigger dollars in South Bend.

Illinois and Iowa will run fairly equal with hourly salaries ranging from $150 to $165, and annual packages averaging $260,000 to $280,000. Both will have a smattering of $300,000 opportunities. Kentucky will offer averages in the $240,000 to $260,000 range, with the odd fee-for-service job providing around $300,000. The widest ranges will be found in Ohio, from $170,000 to $350,000, depending on location and earnings formula. Look for an average in the state of about $230,000.

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All job seekers should be looking for a fair wage for the work required, and the average income for the region, not the high dollars being bandied about in the rumor mills. The highest incomes are earned by experienced EPs in fee-for-service groups located in high payer mix areas that rarely have openings and are difficult to penetrate. Seek a fair wage, preferably with incentive income, and don't forget about the future by failing to consider opportunities that provide strong pension and retirement plans.

© 2006 Lippincott Williams & Wilkins, Inc.

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