With the resurgence of the spring market last season, the news is even better for job seekers this year. We are in the throes of a candidate-driven market, meaning that there are jobs galore in many areas and not enough physicians to fill them.
But it's not all good news. Last month I covered the country's hot spots, but the remaining three regions — the Northeast, West, and Pacific Northwest — will be responsible for only 19 percent of the nation's jobs this year, and more than 60 percent of those will be found in New York and California.
New York will have 63 percent of the Northeast market with strong opportunities in the New York City area, Albany, and Syracuse. Massachusetts will have uncommonly high opportunity around Boston, as will Maine with hospital employers around the state. Connecticut and Rhode Island (mostly Providence) will offer moderate opportunity as will New Hampshire, again predominantly with hospital employers. Vermont, however, will be uneventful. Less than two percent of positions in the Northeast will be rural or open to physicians with primary care certification.
This year the West consists of three states, and only California will provide any real opportunity with 90 percent of the region's jobs. These will be widespread throughout the state including Los Angeles, San Francisco, and the northern realms. San Diego, however, remains a tough place to find work. Principal employers in California will be Valley Emergency Physicians, which is adding new doctors at 20 of their 22 sites, and California Emergency Physicians, both regional groups.
For national contract groups, TeamHealth West and EmCare also will be hiring throughout California. Nevada has a few positions around Las Vegas and a few spots for pediatric emergency physicians. Hawaii is still the land of few jobs, low incomes, and sky-high prices.
Bringing up the rear as usual are the six states of the Pacific Northwest. Washington and Oregon (mostly via Northwest Emergency Physicians) will have a smattering of opportunities, though those in Oregon will be primarily rural. Wyoming also has some positions this year, 30 percent in rural areas. Idaho will have a few opportunities in the Boise area, but Montana and Alaska will offer little to nothing. More than 50 percent of the region's positions will be open to physicians board certified in primary care.
My annual When Pigs Fly Award this year goes to New Orleans. I'm tired of giving it to San Diego, and I think it is high time hospitals and EDs were reconstructed in the Big Easy.
The new candidate-driven market is driving up salaries, spurring the return of the sign-on bonus, and creating a demand for more creative income packages. In the late 1980s we saw a move toward fee-for-service. That idea, while still in use, has been updated to the RVU (relative value unit) model of compensation as both an incentive on top of salary guarantees and as a total income base. Due to the shortage of physician candidates, look for sign-on bonuses and other creative incentives in less popular lifestyle areas. Several hospital employers, particularly in Maine, rural parts of the Midwest, and with Kaiser in California, are even offering assistance with school loans as well as other more unusual incentives.
On the whole, incomes in emergency medicine are rising, not just base salaries but predominantly through performance-based incentives. Physicians earning the highest possible dollars in the specialty are those on partnership tracks with full fee-for-service/RVU compensation plans plus profit-sharing, creating earning potential more than $400,000.
Steve Maron, MD, the president of Valley Emergency Physicians in Oakland, CA, told me that all of their physicians work on a fee-for-service basis, and he reported incomes at one of their established sites in the past few months averaging around $185 an hour and an hourly average of $150 at their newest site.
He emphasized that ED payer mix, strong collection rates, and exemplary documentation are essential to achieve that level of payout. “This compensation method rewards those who work harder,” Dr. Maron said. “With a physician-owned group, there's nowhere for the money to go but back to the docs.”
The regional income reports that follow are based on residency-trained emergency physicians who have employee status with a hospital or private group working about 1,700 hours annually, but do not include bonuses or incentive income unless mentioned. The annual packages include basic benefits (pension, CME, health and life insurance but not malpractice) worth approximately $23,000.
In the Northeast, emergency physicians are earning a high of $140 an hour in Massachusetts and a low of $90 in rural Maine. The average in the region is $125 an hour. With the whole package, the high salary is $300,000 in Massachusetts, the low is $158,000 in Maine, and a regional average of $230,000. A number of hospitals, mostly in Maine, are offering full or partial loan forgiveness.
In the Mid-Atlantic area, the highest hourly rate is $200 in Maryland, the lowest is $100 in Pennsylvania, and the average is $130. With a package, the high is $350,000 in Maryland, the low is $193,000 in Pennsylvania, and the region's average is $260,000. EmCare is paying bonuses and incentives in Maryland, and there are pockets of high salaries of $300,000 and higher in Pennsylvania.
In the Southeast, hourly rates range as high as $200 in Arkansas to a low of $100 in Louisiana, with a regional average of $148. The highest package amounts to $350,000 in Mississippi, the lowest to $187,000 in rural West Virginia, and an average of $275,000. Groups in Tallahassee and Jacksonville, FL, are offering $70,000 in bonuses and incentives with a three-year partnership track. Packages are $300,000 and higher in Augusta and Vidalia, GA, and EmCare in central Florida is offering $50 an hour night differentials. Hourly rates along the Gulf Coast are $160 to $170 an hour, and in Nashville, job seekers can find rates of $190 an hour plus profit-sharing.
In the mid-West, the highest hourly rate of $200 can be found in Detroit, with the lowest of $80 an hour in rural Michigan. The average for the region is $145 an hour. Packages bring the region's high to $355,000 in Detroit, the low to $140,000 in rural Michigan, and the average to $260,000 for the region. In northern Illinois, a rate of about $190 an hour can be found, while the Chicago area averages $150 an hour. There is the potential for $325,000 with a group in Kansas, and EPs can earn $300,000 plus a sign-on bonus and loan forgiveness in Lima, OH. Several groups in Cleveland are offering $300,000 or higher.
In the Southwest, the hourly rate reaches a high of $210 in El Paso, TX, a low of $115 an hour with no malpractice in Colorado, and a regional average of $150. Packages in Texas range up to a high of $380,000, a low of $195,000, and an average of $285,000.
Averages in the Southwest can be attributed to high-income levels in Texas, particularly in areas like El Paso where, according to the principal recruiter for Emergency Service Partners, LLP of Austin, Gretchen Moen, the recruiting team has seen salary expectations rise from $150 an hour to $175 an hour over the past few years. Her group is offering the highest Texas hourly rate in El Paso, though she reports multiple employers offering $200 an hour in Houston.
In the West, the highest hourly rate of $250 is in California, the low of $100 is in Hawaii, and the regional average logs in at $146. Packages range as high as $375,000 in California, as low as $170,000 in Hawaii, with an average of $275,000. Mark Spiro, MD, the chief operating officer of California Emergency Physicians, reported an average range of $160 to $200 per hour for their fee-for-service physicians. “Earnings are site-specific. Whatever the team earns at the site, they split,” he said.
A representative of a large national contract group in California told me that their incentive-based compensation averages $180 an hour.
In the Pacific Northwest, hourly rates range as high as $150 in Montana to $82 in rural Idaho, with an average of $125. The packages are a high of $290,000 in Montana, a low of $140,000 in rural Idaho, and an average of $230,000. Incentive/RVU incomes are $130 to $150 an hour in Washington.
That's the wrap-up. Remember, these predictions do not include “underground” positions, those jobs that are so great they are filled only through recommendation by a current partner. These jobs are never advertised. Like always, use your contacts, set your goals, and hunt wisely!