Part 1 in a Two-Part Series
Like last year, there are far more emergency medicine jobs than there are candidates to fill them. And what's more, the percentage of employers open to primary care physicians is still on the rise. In 2009-2010, the percentage open to hiring primary care physicians with ED experience was 25 percent, last season it was 30 percent, and this year it is more than 35 percent, according to my interviews with employers.
The increase has no correlation with national contract group permeation because that appears to be on the decline. Perhaps even more important is that the increase also appears to have no connection to an increase in rural openings. More direct hospital employers and democratic physician groups of all sizes, however, are designating a portion of their opportunities as open to primary care candidates with ED experience. Location seems to be a significant factor in this trend, as do acuity and census. The impact on those seeking new jobs this season may be an increased difficulty finding a peer group. Very popular lifestyle cities will remain slim pickings this year with the coveted “When Pigs Fly” award going to Salt Lake City, UT. In fact, the whole state pretty much qualifies for that distinction.
Leading the way with available jobs will be the 13 states of the Midwest, providing 29 percent of the country's jobs with 40 percent accepting primary care. Ohio will have 19 percent of the region's jobs with strong numbers in all the major cities, including Cleveland, Cincinnati, and particularly Columbus. The state in second place is a bit of surprise — Missouri with 17 percent; expect a lot of activity around St. Louis but the usual shortage in Kansas City.
Chicago is wide open this year, and Illinois will provide 13 percent of the region's jobs. Indianapolis will have a few openings for a change, and Indiana ranks next in the region. Kentucky, Wisconsin, and Iowa will each have about seven percent of the region's openings, with 84 percent of Kentucky's open to primary care (the highest in the region). Kentucky's jobs are primarily outside the major cities, and Hospital Physician Partners will be a major employer in the state. Wisconsin, at only nine percent, will be the lowest. Look for one or two spots in Madison and Milwaukee as well as Des Moines. Michigan and Minnesota have nothing looming in Detroit, Minneapolis, or the Twin Cities. Bringing up the rear with less than two percent of the region's jobs are Kansas, Nebraska, and the Dakotas, though the few jobs in the Dakotas are more than usually appear there.
The Southeast's 10 states are rife with opportunity, providing more than 27 percent of the country's jobs with Tennessee its new leader. The Southeast also leads the country in accepting primary care at more than 53 percent of the region's employers. Look also for strong numbers in Knoxville, Nashville, and other parts of the state with more than half of the state's employment coming from TeamHealth.
Florida ranks next with 15 percent of the region's jobs. The biggest employer will be the Hospital Corporation of America (HCA), particularly in the Southeast, as they transition all of their emergency departments from contract group staffing into in-house employee status. Look for slots in Tampa/St. Petersburg and Miami as well.
North Carolina will continue to have a drought in the Research Triangle area, but Charlotte and the western mountain region as far as Asheville will be jumping with jobs. Georgia, including Atlanta, will also be hot with Schumacher and Apollo leading the way. Mississippi and Alabama will each have some jobs outside their major cities, many in more rural areas. Mississippi will have the highest percentage of primary care openings at just under 80 percent. South Carolina and West Virginia will offer a lower overall number of jobs, primarily in more suburban regions, and as usual, Charleston is out of the question. Bringing up the rear in the region is Arkansas with primarily rural positions 73 percent open to primary care.
California is the state with the most job opportunities in the country this year, a statistic that helps land the West/Southwest in the number three spot, providing 15 percent of jobs. Major employers in the state include CEP America, Valley Emergency Physicians, and Kaiser Permanente. San Diego remains an EP wasteland, but Los Angeles and San Francisco will have a few openings. Employers in Texas must have hired a lot of physicians last year as the state's job numbers appear to be declining, particularly around Dallas. Houston, San Antonio, and other smaller cities will have strong opportunities, including a few in Austin. Another interesting development is the number of freestanding EDs cropping up in the state looking for physicians. These two states will represent 74 percent of the region's jobs.
Oklahoma will have some new opportunity in Oklahoma City and suburban areas with nine percent of the region's jobs. Arizona and New Mexico will have few jobs, with little in Phoenix, Tucson, or Albuquerque. Nevada has quite a bit of opportunity between with EmCare and HCA around Las Vegas. Denver is looking for a few good pediatric EPs, but that's pretty much it for Colorado. Hawaii and Utah have left the building at least as far as emergency medicine jobs are concerned.
As usual, the six states of the Middle Atlantic region (34 percent primary care acceptance) are led by Pennsylvania with 39 percent of the region's jobs, but the Keystone State is looking for emergency medicine candidates, with only about 20 percent of employers open to primary care. Philadelphia will be wide open with lots of jobs, and Pittsburgh will also have a respectable number. Virginia is second in the region (23 percent) with several positions in eastern parts of the state, including Richmond and around Washington, D.C. New Jersey will provide about 21 percent of the region's jobs with a few in the Philadelphia and the New York City metro areas. Maryland will have positions in Baltimore and near Washington, D.C., and there will actually be a few jobs in the District of Columbia this season. Delaware has the usual openings through ECI in Dover and Milford, both accepting primary care with ED experience. Maryland and Washington, D.C., appear to be the only ones virtually closed to primary care physicians.
Twelve percent of the nation's jobs will be in the Northeast, nearly half of which will be in New York, with a larger number than usual in the Big Apple. There will be some strong opportunity in Boston and the Massachusetts eastern shore region, but Rhode Island is going to be very sparse. Maine will have a few spots in Bangor, but the rest will be in more rural regions. Connecticut, New Hampshire, and Vermont will have some opportunities, but very few in major cities or popular lifestyle regions. Those northernmost New England states may surprise this year with higher-than-usual levels of opportunity. The Northeast accepts the lowest number of primary care candidates at less than 22 percent across the region, less than eight percent in Connecticut, and three percent in Massachusetts.
Finally, the Pacific Northwest will provide less than three percent of the nation's emergency physician openings with nothing at all in Alaska and lower-than-usual numbers in Washington (37 percent of the region) and Oregon (20 percent). Seattle will see some activity for a change, but Portland remains closed to action. Interestingly, Wyoming and Montana have higher levels of opportunity this year including Casper, though most will be in more rural areas. Idaho doesn't look to be providing any help in regional opportunity. About 35 percent of this region's jobs will be open to primary care, mostly due to a higher level of rural employers.
As usual, I will end with a favorite job listing quote. Though jobs are still difficult to find in popular lifestyle areas, many employers and recruiters are pulling out all the stops to attract candidates to jobs located elsewhere. As an employer in Indiana said, “BCEM physicians are enthralled by this exceptional EM opportunity!” I hope you will be equally enchanted with the Compensation Report coming next month.
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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.