Emergency physician incomes for the coming year are largely at last year's levels, with pockets of high dollars and pockets of perks. More hospitals are offering loan forgiveness than last year, and sign-on bonuses of $5,000 to $50,000 still appear depending on location and level of recruiting difficulty.
RVU and fee-for-service wages are topping the pay scale, primarily in partnerships located in strong payer-mix territory like Wisconsin, Texas, Florida, Virginia, Mississippi, California, Illinois, Indiana, Kansas, Ohio, and even Pennsylvania and Washington. Many of these require a minimum of a year or two of lesser income, buy-in for partnership, or both, but once there, the annual incomes can pass the half-million mark. It's a simple equation that all physician partners have endured so those new to the job market should not be looking for special treatment from these exceptional groups because of a high-demand market.
As always, the more desirable the lifestyle area, the more competitive the job and the lower the income. Physicians must job search with an eye to the future, not just what will be earned this year. Look most carefully at earnings for years two to five. What kind of retirement program is available? With health care changes looming, who knows what may happen to EP salaries and fee-for-service incomes? Don't make decisions based on perks like sign-on bonuses that could be spent before you even start. Search for a savvy long-term arrangement, not a quick buck. Understand that employers offering loan forgiveness will be doing so over a period of years, so be prepared to sign a multiple-year contract to earn it. Some employers are paying residents a monthly stipend if they sign on early. That's great if you can get it, but read the fine print. Make sure you aren't digging yourself a hole with a pay-back clause that requires more years of service than you are prepared to give.
The figures in this report are based on incomes from employee and fee-for-service models. The annual package includes an average benefit value of $25,000, excluding malpractice or tail premiums. The numbers are based on 1,600 clinical hours a year, and do not include any perks.
Leading the country in income levels for the first time in a long while is the Midwest, primarily due to the outstanding partnership incomes in Wisconsin. That area's high: $500,000 a year and $300 an hour, plus a statewide average of $170 an hour and $330,000. The average hourly rate for the 13 states in the region is $149; the average package is $281,500. Minnesota follows with an hourly average of $160, but the average package is low because of rural jobs, averaging $265,000. I found highs of $190 an hour and $360,000 in Illinois and $200 an hour and $400,000 in Indiana, with statewide averages of $145 an hour. Kentucky, Kansas, and Ohio have an hourly average in the $145 to $150 range. You'll find $200 an hour in Branson, MO, but the state average is $140 an hour. Iowa shines with an hourly average in the $150 range and an annual package around $400,000 for a partner. Michigan is the lowest earning state with averages of $130 an hour and $230,000 a year. No one in Nebraska and the Dakotas was willing to share financial information. Notable in the area are a rumored $100 sign-on from a group staffing Lima, OH, a great package offered by Mayo Clinic starting at $180 an hour, and a Cleveland group with RVU incomes at $400,000.
Just a baby step behind are the 10 Southeast states with an hourly average of $146 and a regional average package of $265,000. Hourly highs are in Alabama and North Carolina with $215 and $206, respectively, followed closely by Florida, Louisiana, and Mississippi all offering highs at $200 an hour. The average packages in Florida and Mississippi are $300,000 and hourly rates are $150 to $155. Louisiana, Alabama, and North Carolina have average packages between $270,000 and $290,000. Georgia and South Carolina average hourly incomes are $145 to $150 and packages around $280,000. Tennessee averages $140 an hour and $265,000 annually while the Arkansas and West Virginia averages are at $133 an hour and packages at $250,000. Notable in the region is a group in southeast Alabama offering $330,000 to start with partnership earnings at more than $500,000 a year. TeamHealth, the principal employer in Tennessee, offers a base plus RVU incentive topping out at more than $350,000 around Chattanooga and Knoxville, and packages up to $300,000 around the state depending on the site and the experience of the candidate. They're also offering strong perks.
Look for $300,000 packages along western Florida and slightly higher in the east. Louisiana is getting back in the game, according to the Schumacher Group, a principal employer there, with up to $170 an hour for emergency medicine or primary care physicians. Top dollars in Mississippi are in the prison system at $350,000. North Carolina has pockets of high hourly rates in Rocky Mount at $200 and with a coastal group offering $206. The region's high income is in Alabama, and the low income is in West Virginia.
With more than 50 percent of the region's nine states not reporting enough figures to create solid ranges, the West/Southwest wages must be considered on a state-by-state basis. Colorado, Hawaii, New Mexico, Nevada, and Utah are all underreported. Of course, Texas remains at the top with highs reported at $240 an hour at fee-for-service sites, an average of $210 an hour in El Paso, and a statewide average of $165 an hour and $325,000 a year for an emergency medicine candidate. The bigger dollars in Texas are closer to the Mexican border than the large, more central cities. California is all over the scale with fee-for-service incomes ranging from $180 to $230 an hour in more interior regions, and annual packages as low as $172,000 in highly desirable lifestyle areas. Physicians can find $190 to $200 an hour in parts of Oklahoma, and another group in the state is offering a package of $370,000 plus perks galore. EmCare is the principal employer in Nevada running five EDs in Las Vegas offering averages of $175 an hour and $300,000 but with no differentiation between emergency medicine or primary care boards. Arizona averages $125 an hour and $260,000 a year, with some rare fee-for-service highs at $180 an hour and $340,000 a year.
The six states of the Middle Atlantic region have two highs this year. The highest is in western Pennsylvania with a $400,000 package and large sign-on bonus, loan repayment, and full benefits. Though the state averages $250,000 for boarded doctors, the hourly and package averages are location-specific with the western area doubling earnings in the east. Notable in the region is EMA, the major employer in the New York and New Jersey area offering a path to equity ownership that starts as high as $170 an hour with high incomes and benefits to partners. New Jersey leads the region as a result of partner packages between $310 an hour and $360,000 a year, with the western half of Virginia right in there. Both average $150 an hour, while Maryland offers the regional low of $125 an hour, despite one spot in Baltimore with a high rate of $170 to $210 an hour. Washington, D.C., and Delaware were nonresponsive, as usual.
If you want to make good money in the seven states of the Northeast, look to Connecticut where a central state employer is offering a $350,000 package for 1,328 hours a year; that's $260 an hour! The regional average is only $125 an hour due to the abundance of rural opportunities in upper New England and throughout New York. Rhode Island, New Hampshire, and Vermont have few openings, but not enough concrete income information for inclusion. New York, with the most jobs in the United States, averages $130 an hour and packages of $250,000. Highs are in areas like Rome at $300,000, and some employers are offering high sign-on bonuses in the $40,000 range. Connecticut averages $140 an hour and $270,000 a year, and Massachusetts has an average of $140 an hour and $275,000 a year. Maine is the land of perks with lots of loan forgiveness and even some J1 visa spots, but the averages are low at $110 an hour and $225,000 a year. Look for partnerships in and around Boston to come closer to $300,000.
As always, bringing up the rear is the Pacific Northwest with rates under $120 an hour, but with a few surprises including a group in southern Washington offering $400,000 to $450,000 and high numbers of at least $160 an hour at several Montana sites, plus a $330,000 opportunity in Wyoming. Wyoming and Idaho offer an average of $130 an hour and $210,000 a year, and the average in Washington is also $130 an hour, but the package is slightly higher at $250,000 due to incentive bonuses and benefits. Oregon had no substantial numbers to report, and getting salary information in Alaska is as tough as getting a job there.
The Katz Compensation Top 10
8. New Jersey