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Wednesday, January 16, 2019

Happier EPs are Choosing to Stay Put

​BY JACKIE LAM

Few emergency physicians reported wanting to move in 2015, and even fewer said so in our salary survey in 2017. That trend was reflected in both male and female EPs—11.6 percent of women said they did not like where they worked and were planning a move, a slight decline from 11.9 percent two years ago, while 8.3 percent of men said the same, a drop from 9.6 percent in 2015. Female EPs were still more likely than their male colleagues to want to move in 2017, and the gap between the two groups widened to 3.3 percent from 2.3 percent before.

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It's unclear whether board certification affects the decision to relocate, but the tables have certainly turned for board-certified and non-board-certified doctors in that department. The number of non-board-certified EPs who were happy with their location not only increased at a faster pace but also surpassed that of their board-certified counterparts in 2017: A total of 81.1 percent of board-certified EPs said they liked where they worked compared with 80.4 percent in 2015, and 84.6 percent of non-board-certified physicians felt the same compared with 76.4 percent before. Their positions on the other end of the spectrum have also flipped: More non-board-certified EPs (11.4%) than board-certified ones (9.7%) wanted to move in 2015, but more board-certified EPs (9.2%) were eager for a change than their non-board-certified colleagues (8.4%) two years later.

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Willingness to move was directly proportional to decreased career satisfaction in 2015, but our 2017 survey found that more of those who reported high career satisfaction were considering a move imminently. Close to 61 percent of EPs very or somewhat satisfied with their careers said they wanted to move within one year, up from 42.7 percent two years ago, but only 42.4 percent of them were thinking of moving in three years, down from 70.8 percent in 2015. On the other hand, more EPs who were very or somewhat dissatisfied with their careers were opting to stay where they were—38.5 percent said they had no plans to move in 2017 v. 29.7 percent in 2015—and fewer of them wanted to move within one year at 29.7 percent compared with 40.8 percent in our last survey. More of them, however, were contemplating a move within three years at 34.9 percent v. 24.4 percent before.

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Similarly, more EPs who made the most were interested in staying put in 2017, but more of them also reported feeling inclined to move somewhere else. Close to 26 percent of EPs who made more than $350,000, the highest income category in our survey, had no desire to move in 2017, rising from 15.2 percent in 2015. This group, however, also saw an increase in the number of EPs wanting to move within one and three years to 16.7 percent from 8.1 percent and to 21.1 percent from 18 percent, respectively. The same held true for the $300,001-$350,000 group, the next highest salary category: Twenty-one percent of EPs wanted to stay where they worked in 2017 compared with 16.1 percent in our previous survey, while 26.4 percent v. 16.3 percent in 2015 wanted to move within one year and 22.8 percent v. 20.5 percent in 2015 within three years.

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The highest percentage of EPs looking to move shifted to those ages 41 to 45 from EPs 30 to 35 in 2017. Close to 46 percent of emergency physicians 30 to 35 said they wanted to move in 2015, but only 25 percent said so in 2017. More than 41 percent of EPs who were 41 to 45 reported a desire for change, coming up from 27 percent in 2015. In fact, the number of EPs contemplating a move increased across all age groups from the 36-to-40-year-old cohort up, except for those who were 56 to 60 (16.2% in 2017 v. 35.5% in 2015).

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Staff EP continued to be the job title associated with the highest mobility in 2017, with 68.8 percent saying that they were planning to move within one year and 82.1 percent within three years. Even so, those numbers have dropped from 84.6 percent for one year and 92.9 percent for three years in 2015. EPs at executive-level positions, however, have become more interested in change in 2017; the percentage of those working as a chief or director of an ED and wanting to move within one year rose to 16.9 percent from 14.1 percent in 2015 and that within three years inched up to six percent from 4.8 percent two years before.

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Employer satisfaction appeared to be a more reliable predictor of whether EPs wanted to move than career satisfaction. Those who were very or somewhat satisfied with their employers were even happier with where they worked in 2017, and that translated into smaller percentages of them seeking a change in location within one year at 24 percent, falling from 29.9 percent in 2015, and within three years at 25.8 percent, a decrease from 48.8 percent before.

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The desire to move stayed largely the same across employer types between 2015 and 2017 with a few small changes. Fewer EPs employed by independent EP groups said they had no intention to move at 25.2 percent in our 2017 survey compared with 35.3 percent in 2015, and more of them were considering moving within one year at 23 percent compared with 20 percent before. Similarly, only 0.7 percent of locum tenens EPs planned to stay where they were when 1.7 percent of them said so in 2015, and 5.4 percent of them planned to move within one year, up from 1.3 percent in our last survey. More contract management and hospital employees, however, said they were staying put at 31.3 percent (22.7% in 2015) and at 42.9 percent (40.3%), respectively.

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Wednesday, December 19, 2018

Board Certification on the Rise despite Movement against MOC

​BY JACKIE LAM

The movement to abolish MOC is gaining momentum across specialties, so we expected the number of EPs seeking board certification to drop. But that was just not the case in the latest EMN salary survey: The percentage of EPs who were board-certified rose to 85.2 percent in 2017 from 81.2 percent in 2015, and the percentage of EPs who did not have board certification fell to 14.8 percent from 18.8 percent two years ago.

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That wasn't the only surprise. More EPs, board-certified and non-board-certified, worked in remote areas in 2017, increasing to 1.3 percent from 0.6 percent in 2015 and to 2.2 percent from 0.4 percent, respectively. Non-board-certified EPs still mostly resided in urban areas in 2017 at 35 percent v. 37 percent in 2015, but board-certified EPs transitioned away from those areas, with 36.6 percent saying they lived in an urban locale compared with 42.4 percent two years ago. Most board-certified doctors still lived in suburbia, with that percentage inching up further to 47.8 percent in 2017 from 45.1 percent in 2015. More of those with board certification also said they lived in rural areas at 14.3 percent in 2017 compared with 11.9 percent before.

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EPs have gone through not only a change in locale but also a change of pace in the ED over the past two years. Most emergency physicians, regardless of board certification, still worked in high-volume EDs with more than 30,000 annual visits but at slightly lower percentages compared with 2015—74 percent in 2017 v. 76.5 percent in 2015 for board-certified doctors and 45.8 percent v. 50 percent for their non-board-certified colleagues. Some EPs from both groups migrated to EDs that saw fewer patients but more so for those without board certification. The percentage of non-board-certified EPs who worked in EDs with 1,001-5,000 visits per year grew to five percent from three percent in 2015, and that rose in EDs with 15,001-20,000 annual visits to 11 percent from nine percent two years ago.

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This trend is also evident in the number of ED beds. Fewer EPs, with or without board certification, worked in EDs with more than 50 beds, the highest bed count in our survey in 2017, but that decline was more pronounced among non-board-certified doctors. More than 16 percent of board-certified EPs said their EDs had more than 50 beds, down from 17.8 percent in 2015, while only 7.9 percent of their non-board-certified peers said the same, compared with 11.3 percent in our previous survey. Board-certified EPs still mostly fell in the 31-40- and 41-50-bed groups, with percentages in those categories increasing to 18.6 percent from 18 percent and to 15.1 percent from 14.5 percent, respectively. It's the reverse, however, for their non-board-certified counterparts: Most of them were concentrated in the lower end of the spectrum, with the percentage of EPs without board certification who reported working in EDs with fewer than 10 beds hiking up to 20.9 percent in 2017 from 14.6 percent in 2015 and that in EDs with 21-30 beds rising to 23.3 percent from 18.2 percent before.

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The distributions of board-certified and non-board-certified EPs were more similar in our hospital bed data. Both groups were more likely to be in smaller hospitals, but the number of non-board-certified EPs working in hospitals with fewer than 100 inpatient beds increased more substantially: 42.1 percent in 2017 v. 33 percent in 2015. The percentage of board-certified EPs working in hospitals with fewer than 100 beds also went up slightly to 17.5 percent from 21.4 percent. The majority of board-certified doctors were still found at hospitals with 101-300 beds in 2017 at 37 percent, the same as in 2015.

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More EPs, board-certified or not, planned to make a move, but more doctors without board certification reported that—81.1 percent of board-certified EPs (80.4% in 2015) v. 84.6 percent of non-board-certified EPs (78.1% in 2015). A similar number of board-certified EPs (about 10%) said they were not planning to move in 2015 and 2017. Fewer non-board-certified EPs said they had no intention to move, however, at 7.1 percent, dropping from 10 percent two years ago.

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Not surprisingly, given how many more non-board-certified doctors said they worked in lower-volume EDs and smaller hospitals compared with our last survey, 11.1 percent of them cited wanting to move to larger hospitals as the reason to move while none of them reported that as a motivating factor in 2015. This contrasts starkly with board-certified EPs, only four percent of whom said they wanted to move to a bigger hospital. Overall, money was the most cited reason for wanting to move, with 50.8 percent of board-certified doctors (20.9% in 2015) and 38.9 percent of non-board-certified EPs (13.3% in 2015) reporting that they wanted to move to get a better salary. Back in 2015, the main motivator for a move was better location for both groups—21.7 percent of board-certified doctors (40.5% in 2017) and 20 percent of non-board-certified ones (27.8% in 2015).

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Tuesday, November 20, 2018

Female and Male EPs Nearly Equal in Board Certification

​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

The Gradual Rise of Female Leaders in EM

​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

Female EPs Inch Closer to Equal Pay

​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.​