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Tuesday, November 20, 2018

​BY JACKIE LAM

Female EPs are very close to attaining equality with male EPs, at least in board certification. The number of board-certified female EPs has increased significantly since the last EMN salary survey in 2015, so much so that it almost pulled even with the number of board-certified male EPs in 2017. Eighty-four percent of female physicians reported having board certification in our 2017 survey, compared with 74 percent two years ago, while 86 percent of male physicians said they were board-certified, an increase from 84 percent in 2015. The board certification gap between the two genders has narrowed to two percent from 10 percent over the span of two years.

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The trend in board certification and age wasn't so clear-cut. Take the age group with the highest percentage of doctors with board certification: More of those over 56 said they were board-certified—26 percent—in 2017 compared with 20 percent before, but more of them also said they didn't have board certification: 43 percent v. 35 percent in 2015.

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Those findings were reflected in the data on years in practice and board certification: A higher number of more experienced EPs said they were board-certified compared with two years prior, specifically those who had been in the specialty for 16-20 years, 26-30 years, and more than 30 years. The percentage of physicians who reported themselves as board-certified rose to 16 percent in 2017 from 13 percent in 2015 for the 16-to-20-year group, to nine percent from seven percent for the 26-to-30-year cohort, and to 13 percent from 11 percent for those who had more than 30 years of experience in EM.

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Most EPs, board-certified and non-board-certified, still worked in hospitals or health care systems. What's different in 2017 was that fewer doctors in this practice setting said they were board-certified—78 percent v. 80 percent in 2015—and significantly more of them did not have board certification—82 percent v. 71 percent in 2015. On the other hand, while the number of board-certified EPs working in an academic or university setting remained the same at 13 percent in 2017, fewer EPs said they did not have board certification at five percent, dropping from 10 percent in 2015. Similarly, lack of board certification became less common among EPs in urgent care (4% in 2017 v. 7% in 2015) and freestanding EDs (3% in 2017 v. 4% in 2015).

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The majority of EPs stayed put in community nonprofit hospitals between 2015 and 2017, and the percentage of those with board certification was again 36 percent in our most recent survey. The number of non-board-certified EPs, however, fell to 31 percent from 33 percent in 2015. In fact, a general decline in board certification was observed across types of hospitals, except for private nonprofits and VA/military facilities. Twenty-three percent of respondents who worked in private nonprofits said they were board-certified compared with 21 percent in 2015.

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Hospitals or health care systems replaced independent EP groups as the employer with the highest percentage of board-certified EPs in 2017. While the number of EPs who were employed by a hospital or health care system and had board certification held steady at 37 percent from 2015, that of board-certified physicians working for independent EP groups fell to 34 percent in 2017 from 39 percent in 2015. It stands to reason then that the percentage of non-board-certified EPs working for independent groups increased, to 25 percent from 23 percent two years ago, to be exact. Contract management groups were the only employer category that saw an increase in board-certified employees (27% v. 23% in 2015).

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The employer satisfaction and dissatisfaction between EPs with and without board certification were neck and neck in 2015, with board-certified physicians reporting feeling a bit happier. Seventy-six percent of board-certified EPs said they were very or somewhat satisfied with their employers, while 75 percent of EPs not holding board certification said so. Slightly more non-board-certified doctors said they were very or somewhat dissatisfied with their employer at 16 percent compared with 14 percent of their board-certified peers. Non-board-certified EPs said they were very or somewhat satisfied with their employers at 78 percent compared with 73 percent of their board-certified colleagues, but fewer non-board-certified doctors also reported feeling very or somewhat dissatisfied with their employers at 11 percent compared with 17 percent of board-certified ones.

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Those without board certification also felt happier with their careers than those who had board certification in 2017, which was also the case in our 2015 survey. Back then, 86 percent of non-board-certified doctors said they felt very or somewhat satisfied with their careers, while only 83 percent of board certification holders said so. That gap had widened in 2017, with 89 percent of non-board-certified EPs feeling very or somewhat satisfied with their careers and 83 percent of their board-certified counterparts saying so.

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Next month: Then and Now: Board Certification, Part Two. We'll cross-reference board certification with locale, ED visits, plans to move, and more in next month's salary survey article. We'll also publish that article ahead of print in our enews. Sign up for the enews (free!) at http://bit.ly/EMNenews. You can also find past salary survey articles with additional tables in the Emergency Medicine News Salary Survey blog at http://bit.ly/EMNSalarySurvey.

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Tuesday, October 16, 2018

​BY JACKIE LAM

More female EPs have been given management responsibilities, but the bulk of those still appear to be held by their male colleagues, according to the 2017 EMN Salary Survey. Fewer women said they didn't manage anyone, however, at 72 percent in 2017 compared with 75 percent two years prior.

The 2015 and 2017 results across the number of employees managed remained largely the same, except for the 16-20, 21-25, and more-than-30 groups. Previously, only one percent of female EPs said they supervised 16-20 employees, but that jumped to three percent in 2017. On the flip side, fewer female physicians reported managing 26-30 people at one percent, down from two percent in 2015, and more than 30 employees at seven percent, a decrease from six percent before.

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The average ages of male and female EPs inched up to 49 years old from 48 in 2015 and to 46 from 45, respectively. The number of women pulled even with that of men in the older age groups of 46-50 and 51-55 in 2017 at 16 percent and 14 percent, respectively. More male EPs (15%) fell in the 46- to 50-year-old population than female EPs (11%) in our 2015 survey, and this was true also in the 51- to 55-year-old demographic (13% of men v. 11% of women). Men continued to dominate the older-than-60 category, however. The distance, in fact, widened between the two genders in this age group—seven percent of women and 15 percent of men fell into this group in 2015, but eight percent of women v. 19 percent of men reported themselves to be over 60 in 2017.

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This perhaps correlates with how long female EPs stay in practice. The average number of years of practice has increased for men and women in EM to 18 years from 17 years and to 14 years from 13 years, respectively, compared with 2015. Most female EPs still reported six to 10 years of practice, with an even higher number, 26 percent, saying so in 2017 compared with 23 percent in 2015, and most male EPs, 18 percent of them in 2017 v. 19 percent in 2015, said they had been in practice for 11 to 15 years. The percentage of EPs still dropped off as the years of practice increased for both genders in 2017, but fewer women said they had been in practice for more than 30 years (6% v. 5% in 2015) and more men said so, 17 percent compared with 13 percent two years ago. More women reported being in the next highest category of 26 to 30 years at six percent compared with five percent in 2015, but that still lagged behind the 10 percent of men (8% in 2015) with the same number of years of experience.

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Similarly, the percentage of women who self-identified as a chief or director of an ED increased to eight percent from four percent in 2015, still smaller than the percentage of men in the same position, which rose to 15 percent in 2017 from 14 percent before. The good news here, however, is that women are closing that leadership gap with men and the number of women holding the ED chief or director title increased at a greater rate than that of men over the past two years. The percentage of women who reported themselves to be staff emergency physicians decreased to 66 percent from 69 percent in 2015, perhaps because more women moved up the ladder. That percentage remained unchanged for male survey respondents at 73 percent from 2015 to 2017. Men and women were equally numbered in the EM residency director and EM resident categories at two percent and one percent, respectively.

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Gender differences didn't come into play in terms of locale in 2015, and that held true in our 2017 survey. One interesting finding was a shift toward suburban and remote areas for men and women in 2017. Forty-five percent of women said they lived in a suburban area compared with 43 percent before, and 46 percent of men reported the same v. 42 percent in 2015. No women reported living in a remote area in our last survey, but three percent said they did in 2017. The percentage of male respondents living in a remote area stayed the same at one percent between the two years.

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Most EPs still worked in EDs with more than 30,000 visits per year, but fewer in both genders reported that compared with 2015. Seventy percent of female EPs and 73 percent of male EPs said they worked in an ED that saw more than 30,000 visits a year in 2015, but only 68 percent of women and 71 percent of men reported that in 2017. The women from that group seemed to have migrated to EDs with 20,001 to 25,000 annual visits: The percentage of female EPs working in these EDs increased to six percent from three percent in 2015. It's more difficult to trace where male EPs moved because they are evenly distributed across categories, but the 10,001-15,000 group saw the biggest increase to five percent from four percent in 2015.

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Next month: Then and Now: Board Certification. We'll cross-reference board certification with gender, age, years in practice, type of employer, and more in next month's salary survey article. We'll also publish that article ahead of print in our enews. Sign up for the enews (free!) at http://bit.ly/EMNenews. You can also find past salary survey articles with additional tables in the Emergency Medicine News Salary Survey blog at http://bit.ly/EMNSalarySurvey.

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Ms. Lam is the associate editor of Emergency Medicine News.

Tuesday, September 18, 2018

​BY JACKIE LAM

Men continue to make more than women in emergency medicine, but the tide seems to be turning in favor of female EPs. In the last EMN Salary Survey, female EPs earned an average annual salary of $215,338, and male EPs made $267,623 per year on average. That may raise the question of how things are better for women because the 2017 numbers are so similar to those of 2015—the average salary of female EPs was $255,547 and that of male EPs was $299,108 in 2017. Comparing the 2015 and 2017 results, however, reveals that women's average salary increased at a greater rate than men's, and the average salary gap between the two genders has become smaller in the span of two years.

The average salary of female EPs increased by 19 percent, while that of male EPs rose by 12 percent. Previously, men were making 24 percent more than women in the specialty, but that difference narrowed down to 17 percent in 2017.

Our readers clamored for hourly rate data for a fair comparison of income between the two genders when we released our 2015 results, so we added questions about hourly rates this time. We're glad we did because we get to offer some good news—while male EPs still made more than female EPs on average per hour ($195 v. $175), they only made 11 percent more than their female colleagues, a smaller pay difference than when comparing average salaries.

Career satisfaction followed a similar trend: Male EPs still reported higher career satisfaction than their female colleagues, but that distance appeared to be closing and EM women's career satisfaction increased at a higher rate than their male counterparts'. The percentage of female EPs feeling very or somewhat satisfied with their careers hiked up to 85 percent in 2017 from 77 percent in 2015, an eight percent increase, while the percentage of male EPs feeling that way inched up to 86 percent from 84 percent before, up by two percent. On the flip side, the number of women dissatisfied with their careers was still higher in 2017 and career dissatisfaction increased in both groups compared with 2015, but career dissatisfaction grew at a higher rate among men than women. Eighteen percent of female EPs said they were very or somewhat dissatisfied with their careers in 2017 (15% in 2015) v. 15 percent of male EPs (9% in 2015), a three percent v. six percent increase in career dissatisfaction.

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The majority of men and women in emergency medicine continued to report feeling very or somewhat satisfied with their employers in 2017, with close to 70 percent of female EPs and 75 percent of male EPs saying so. Once again, men outnumbered women in employer satisfaction in our survey, but a comparison of the 2015 and 2017 data offers a different story: The percentage of male EPs very or somewhat satisfied with their employers actually fell from 78 percent in 2015, while the percentage of female EPs in this category rose from 68 percent. Similarly, the percentage of female EPs very or somewhat dissatisfied with their careers decreased to 18 percent from 21 percent in 2015, but the percentage of male EPs very or somewhat dissatisfied with their careers increased to 15 percent from 13 percent two years ago.

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The good news for both genders is that most female and male physicians still clocked in less than 40 hours a week in 2017 at 54 percent and 45 percent, respectively. Compared with our previous survey results, however, fewer women reported working less than 40 hours (57% in 2015), while more men said so (42% in 2015). That doesn't necessarily mean men put in fewer hours in 2017—the percentages of female and male EPs working more than 51 hours increased to 13 percent from nine percent in 2015 and to 16 percent from 15 percent, respectively. The number of hours spent seeing patients was still proportional to the number of hours worked, with a majority of female and male EPs saying more than 30 hours of their time each week were dedicated to seeing patients. The percentages of physicians, male and female, who reported spending this much time with their patients have fallen, however, compared with 2015: More than 52 percent of women logged 31 or more hours with patients in 2017, down from 60 percent, while 61 percent of men reported spending that much time with patients, decreasing from 68 percent in our last survey.

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The amount of time female and male EPs spent on paperwork each week changed more drastically: Administrative tasks like completing medical records took up more of female physicians' time than they did their male colleagues' in 2017 v. 2015. The percentage of women who said they dealt with paperwork for more than 21 hours a week increased to 17 percent from nine percent in 2015, while the percentage of men who spent that much time on administrative tasks stayed constant at 16 percent over two years. It's also worth noting that women outnumbered men in the categories of spending 21-30 hours, 31-40 hours, and more than 40 hours on paperwork, while it was the reverse in 2015.

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Another surprising finding in gender difference was board certification. More female EPs (90%) than male EPs (88%) said they were board-certified in 2015, but more men (86%) than women (84%) reported having board certification in our most recent survey. These results also showed that the number of board-certified EPs decreased in both groups between 2015 and 2017.

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As the discussion of physician wellness spreads, it's no wonder that more EPs, male and female, said they prioritized work-life balance compared with before. Close to 84 percent of female EPs and 86 percent of male EPs said they wanted to be paid fairly but job and lifestyle were as important as salary v. 79 percent of female EPs and 82 percent of male EPs saying so in 2015. In contrast to this, the percentage of female EPs willing to accept a lower salary for the job and lifestyle they wanted fell to 13 percent from 15 percent in 2015, but that of male EPs stayed the same at 12 percent in 2017.

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EPs of both genders were also swept up in the wave of change toward goal achievement when it comes to the type of salary increase they received in 2017. Their numbers on this were on par with each other: Fewer female and male EPs said their pay raise was based on a flat percentage at 62 percent, compared with 66 percent and 64 percent, respectively, in 2015. While 36 percent of men and 34 percent of women said goal achievement determined their salary increase in our last survey, 38 percent of male physicians and 39 percent of their female colleagues said so in 2017.

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Next month: Then and Now: More on Gender. We'll cross-reference gender with title, age, practice locale, years in practice, and more in next month's salary survey article. We'll also publish that article ahead of print in our enews. Sign up for the enews (free!) at http://bit.ly/EMNenews.

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Ms. Lam is the associate editor of Emergency Medicine News.​

Tuesday, August 21, 2018

BY JACKIE LAM

Emergency physicians are becoming happier and happier with their careers, especially freshly minted ones.

Bright-eyed and bushy-tailed EPs in their first or second year of practice still reported the highest level of career satisfaction in 2017 compared with their colleagues who have been in the specialty longer. In fact, even more newbie EPs said they were very or somewhat satisfied with their careers in 2017 (97.4%) than two years ago (89.5%). Those with 26 to 30 years of practice under their belts came out second in career satisfaction, with 88.6 percent of them reporting feeling very or somewhat satisfied with their careers (76.7% in 2015). They unseated 2015's second-most satisfied group, EPs who have been practicing for more than 30 years, which ranked third in career satisfaction in 2017 with 88 percent saying they were very or somewhat satisfied with their careers, a slight dip from 88.4 percent in 2015.

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It stands to reason that younger EPs are probably the happiest among all age groups, and that's exactly what our 2017 survey data reflect. All of our survey respondents aged 26 to 30 years said they were very or somewhat satisfied with their careers, even higher than the 90 percent in 2015. Next up are those older than 60, 88.9 percent of whom reported career satisfaction in 2017 (v. 86.7% in 2015). These upward trends were noted across all age groups, except for the 36-to-40 demographic, which suffered a decrease to 80.5 percent in 2017 from 88.1 percent two years prior.

Our latest salary survey found that overall career satisfaction was largely the same in 2017 compared with 2015, with only a few minor changes (for the better). A total of 84.2 percent of emergency physicians reported feeling very or somewhat satisfied with their careers, while 83.5 percent said so in our 2015 survey. On the other end of the spectrum, the percentage of EPs somewhat or very dissatisfied with their careers remained constant at 10 percent.

EPs seemed to derive even greater enjoyment in having more professional responsibilities, including managing employees, in 2017 than they did two years before. Close to 95 percent of those who managed more than 30 employees were very or somewhat satisfied with their careers, up from the already-high number of 90.5 percent in 2015. Fewer EPs with 16 to 20 employees under their wing reported feeling very or somewhat satisfied in 2017, but they continued to rank second in career satisfaction at 90.8 percent v. 97.8 percent in our last survey. Those who oversaw 11 to 15 employees reported the third highest satisfaction rate: More than 90 percent said they were very or somewhat satisfied in 2017, compared with 88.2 percent in 2015.

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This explains why chiefs and directors of EDs had the greatest career satisfaction compared with staff EPs and EM residency directors in our 2017 survey. Close to 92 percent of chiefs said they felt very or somewhat satisfied with their careers, compared with 87.4 percent in 2015. Not as many EM residency directors, who had the highest career satisfaction by title in our previous survey, were as happy with their careers two years later—88 percent of them said they were very or somewhat satisfied, falling from 91.6 percent in 2015. Even though staff EPs still reported the lowest percentage of very or somewhat satisfied physicians among the three categories at 82.5 percent in 2017, this percentage is still a step up from their 2015 record of 81.6 percent.

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It comes as no surprise that the more satisfied EPs are with their employers, the more satisfied they are with their careers. Our data from the 2017 salary survey, however, offered a nice surprise: EPs reported higher career satisfaction regardless of how happy they were with their employers. More than 93 percent of EPs reported themselves as very satisfied with their employer, increasing from the already-high 91.8 percent two years prior. Of those who said they were somewhat satisfied with their employers, 89.9 percent reported feeling very satisfied with their careers, while only 76.5 percent of this group said the same in 2015. Jumping to the other end of the spectrum, career satisfaction climbed higher even among those who were very dissatisfied with their employers in 2017—54 percent said they were very satisfied with their careers, but only 45.5 percent said so in 2015.

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The picture doesn't look as rosy when we turn our focus to career satisfaction by employer type, however. Those who worked for independent EP groups held the highest percentage of physicians very or somewhat satisfied with their careers at 44 percent in 2015, but it dropped to 38 percent in 2017. EPs employed by hospitals and health care systems drew even with their independent group colleagues at 38 percent, up from 32 percent in 2015. The satisfaction among contract management-employed EPs dropped slightly to 21 percent from 22 percent, but they saw a tangible increase in the number of those who reported feeling very or somewhat dissatisfied with their careers—35 percent in 2017 v. 28 percent in 2015.

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Compensation for administrative tasks like paperwork and completing medical records is still tied to high career satisfaction, with 90.7 percent of EPs who were paid for completing these tasks saying they felt very or somewhat satisfied with their careers in 2017, up from 87.9 percent in 2015. Even though the percentage of EPs who were not compensated for admin time felt very or somewhat satisfied with their employers also increased—79.3 percent in 2017 compared with 78.9 percent in 2015—the gap between the two groups widened from nine percent to 11.4 percent.

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Higher salary increases also correlated with higher career satisfaction in our 2015 salary survey. Not so much in our 2017 survey: Not only did the percentages of those who received 2.1 to 5 percent salary raise and felt very or somewhat satisfied with their careers increase to 89. 4 percent and 89 percent from 88.8 percent and 86 percent, respectively, they also surpassed the percentage of EPs who received more than seven percent increase in salary, which was 88.7 percent in 2017 and 91.7 percent in 2015.

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Next month: Then and Now: A Closer Look at Gender. We'll cross-reference gender with salary, career satisfaction, board certification, type of employer, and more in next month's salary survey article. We'll also publish that article ahead of print in our enews. Sign up for the enews (free!) at http://bit.ly/EMNenews.​

Ms. Lam is the associate editor of Emergency Medicine News.

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Tuesday, July 17, 2018

BY JACKIE LAM​​

We all know money can't buy happiness, but a higher salary does seem to make for happier EPs, at least in our latest salary survey.

The salary category with the largest percentage of very satisfied EPs was $325,001-$350,000 at a whopping 51 percent (up from 39% in 2015). This group also saw the lowest percentage of very dissatisfied EPs: zero percent, a decrease from four percent in 2015. The runner-up surprisingly was not the highest salary range but those making $150,001-175,000, 49 percent of whom said they were very satisfied with their careers, a big increase from 31 percent in 2015. No EPs in this salary range reported extreme dissatisfaction, down from nine percent two years ago.

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 It's intuitive to associate low salary with low career satisfaction, but that just wasn't the case in our survey: The percentage of EPs who were very satisfied with their careers is way higher at 52 percent in the under $100,000 a year cohort than other income ranges in 2015. Fast forward to 2017, this group fell a few notches in career satisfaction—only 45 percent said they were very satisfied, and those very dissatisfied rose from zero percent to 1.3 percent. EPs making $175,001-$200,000 reported a decline in career satisfaction, with only 23 percent saying they were very satisfied compared with 33 percent in 2015, and seven percent reporting feeling very dissatisfied, up from five percent in our previous survey.

EPs were generally less satisfied with their careers than they were when we surveyed them two years ago, but that likely comes as no surprise with articles about burnout everywhere you turn. That's reflected in our latest salary survey: Forty percent of EPs reported feeling very satisfied with their careers in 2015 compared with only 38 percent in 2017. The percentage of EPs somewhat satisfied with their careers, however, inched up from 35 percent to 36 percent in two years, as did the percentage of those who were neutral on the topic: 11% in 2017 v. 10% in 2015. As in 2015, 10 percent of EPs said they were somewhat dissatisfied with their careers, but those saying they were very dissatisfied with their careers rose a little—six percent in 2017 compared with five percent in 2015.

Gender also seemed to affect career satisfaction. Male and female EPs were still about equally satisfied with their careers in 2017, but male EPs reported feeling very or somewhat satisfied at 86 percent v. 84 percent in 2015. Fewer female EPs felt the same, decreasing from 81 percent to 79 percent. The level of dissatisfaction remained the same between the two years for both genders; more women, however, were very or somewhat dissatisfied at 13 percent compared with nine percent of men in 2017.

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Advanced age correlated with higher career satisfaction in 2015, and that trend continued in 2017. The percentage of those between 26 and 30 years old who were very or somewhat satisfied with their jobs stayed the same at four percent, still the lowest across all age groups. EPs aged 31 to 40 years saw a sharp decline in satisfaction, however: Only 17 percent of them and 26 percent of those 36 to 40 said they were very or somewhat satisfied, compared with 25 percent and 38 percent in 2015, respectively. The 31-35 age group ranked second in career satisfaction in our last survey, but lost that place in 2017 to the 41-45 cohort (34% v. 33% in 2015). All age ranges over 41 saw an increase in the percentage of those very or somewhat satisfied in 2017, with EPs over 60 reporting the highest percentage at 36 percent v. 26 percent in 2015.

Surprisingly, career dissatisfaction decreased among younger EPs but increased among their older colleagues. The percentage of those very or somewhat dissatisfied fell from two percent to zero percent in 26-to-30-year-olds, from 22 percent to 18 percent for those aged 31 to 35 years, and from 27 percent to 26 percent in the 36-40 group. Every age group over age 41—except for those 46-50—reported a higher percentage of dissatisfaction in 2017 compared with two years ago. The 41-45 group overtook the 46-50 group, which held the highest percentage in 2015. About 42 percent said they felt very or somewhat dissatisfied with their careers, up from 38 percent in 2015.

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It's unclear whether board certification affects EPs' career satisfaction one way or another, but non-board-certified EPs seem to be happier with their careers than board-certified ones. Board-certified and non-board-certified EPs experienced an increase in career satisfaction, with those reporting feeling very or somewhat satisfied rising to 83 percent and 89 percent, respectively, in 2017. The gap between the two widened considerably in two years, however: About the same percentage of board-certified and non-board-certified EPs were very or somewhat satisfied with their careers in 2015—82 percent and 83 percent, respectively—amounting to a one-percent difference, but that disparity stretched to six percent in 2017.

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The shake-up is also evident in our survey's work environment data. EPs at freestanding EDs ranked highest in career satisfaction, with 89 percent of them reporting feeling very or somewhat satisfied v. 86 percent in 2015. Those in academia were dethroned as the most satisfied group, falling to second place in 2017. More hospital EPs were very or somewhat satisfied in 2017 at 85 percent, up from 82 percent. There were only four critical care responses, so it would be unfair to make an inference with this group.

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Not as many or as drastic changes were found in our data about the type of hospital where EPs work. Those in university institutions still had the highest career satisfaction at 88 percent in 2017, even though it decreased from 90 percent in 2015. Those working in nonprofit community hospitals were the second-highest at 85 percent in 2017 v. 81 percent in 2015, surpassing the previous runner-up, physicians in nonprofit private hospitals, 85 percent of whom reported feeling very or somewhat satisfied compared with 84 percent in 2015. The satisfaction level among for-profit community hospital employees stayed the same at 82 percent, but inched up slightly for physicians in for-profit private hospitals to 81 percent (80 percent in 2015). Satisfaction among EPs at VA/military hospitals also climbed from 80 percent to 82 percent in our last survey.

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EPs certainly enjoy their work—the more patients they see, the happier they are. More than 85 percent of those who worked in EDs that had more than 30,000 visits a year said they were very or somewhat satisfied with their careers compared with 84 percent in 2015, and they tied for first place with EPs in EDs with 15,001-20,000 annual visits (85% v. 83% in 2015). They were closely followed by physicians in EDs with 20,001-25,000, 84 percent of whom reported feeling very or somewhat satisfied with their jobs (up from 81 percent two years ago).

Our survey found that those seeing fewer patients were unhappiest with their jobs. EPs working in EDs that saw 5,000-10,000 visits per year had the highest dissatisfaction rate; 14 percent said they felt very or somewhat dissatisfied v. 12 percent two years before. It's important to note, however, that dissatisfaction decreased across all groups in this category in 2017.

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No matter the employer type, however, EPs seemed to be getting happier. Those working for independent groups were the most satisfied, with 86 percent of them saying so compared with 84 percent in 2015. Close to 84 percent of EPs employed by hospitals reported feeling very or somewhat satisfied (82% in 2015), as did 83 percent of those who worked for contract management or staffing groups (82% in 2015) and 83 percent of locum tenens EPs (78% in 2015).

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EPs in urban areas still led in career satisfaction at 86 percent, unchanged from 2015, but their suburban peers were quickly catching up at 85 percent (v. 81%), closing the previous gap of five percent to one percent. Those working in rural areas also reported improved satisfaction, with 82 percent saying they were very or somewhat satisfied with their careers compared with 78 percent before. The picture for remote EPs, however, shifted just as dramatically: Only 59 percent felt very or somewhat satisfied in 2017 v. 100 percent in 2015.

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We'll leave you with one piece of good news: EPs were becoming more satisfied with their careers regardless of where they practiced. The Mountain area (AZ, CO, ID, MT, NV, NM, UT, WY) stood out with the highest percentage of EPs reporting feeling satisfied at 92 percent v. 85 percent in 2015, followed by the West North Central and East South Central areas both at 90 percent (previously 89% and 80%, respectively). Other regions, including the Northeast (CT, ME, MA, NH, RI, VT), Mid-Atlantic (NJ, NY, PA), East North Central (IL, IN, MI, OH, WI), and West South Central (AR, LA, OK, TX), all experienced an increase in career satisfaction. The exceptions were the South Atlantic (DE, DC, FL, GA, MD, NC, SC, VA, WV), which saw a slight dip in that from 85 to 84 percent , and the Pacific (AK, CA, HI, OR, WA), which experienced a bigger drop from 84 percent to 80 percent.

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Next month: Then and Now: How Satisfied Are Emergency Physicians with their Employers? We'll cross-reference career satisfaction data with employer, years in practice, age, title, and more. We'll also publish that article ahead of print in our enews. Sign up for the enews (completely free!) at http://bit.ly/EMNenews.

Ms. Lam is the associate editor of Emergency Medicine News.​

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