In the past 10 years, emergency physician salaries have increased 31 percent while the average clinical hours worked have gone down 12 percent. Currently, the national norm remains $200 an hour. However, nothing about emergency physician compensation is normal due to the supply-and-demand market. The disparity of incomes from state to state and region to region is vast and constantly changing. The more popular the lifestyle or location, the lower the income. The question arises, How sustainable are these gains? Small democratic groups that historically led income levels are disappearing as hospitals and health care companies seek to save money in their emergency departments by bringing in larger national groups or bringing the physicians in house as employees. In my opinion, it may be time to at least start a dialogue about creating some semblance of consistency with emergency physician compensation.

Trends for this year include:

• Big sign-on bonuses are back, particularly in geographically undesirable areas; $50,000 to $100,000 is not unusual.
• Small democratic group buy-ins are dwindling. New physicians won’t accept them.
• There is a significant drop in compensation inclusion in job ads, especially in states such as Maryland, Oklahoma, Maine, and Rhode Island.
• Low salaries in high-cost-of-living areas, such as New York City and San Francisco, remain an issue for emergency physicians.

There has been very little change in regional income levels, with some areas up 3 percent and others down 3 percent. The numbers are based on 1,632 hours per year and include incentive bonuses and relative value unit compensation where applicable. Annual package numbers include basic benefits valued at $30,000. Sign-on bonuses, loan assistance, and other perks are not included. Rankings are based on state averages, not the sporadic highs. (See Figure 1 for the top 10 and bottom 10 states in terms of overall compensation.) You can also visit ACEP’s comprehensive archive of industry and EM-specific salary and compensation information.

The Southeast continues to lead the country, with an average hourly/annual salary of $231/$406,000, and 40 percent of jobs available are open to primary care (PC) boarded physicians.

Alabama: Average: $224/hr., $395,000 ann.; 44% PC boards; high of $500,000 ann.; up 9%
Arkansas: Average: $225/hr., $397,000 ann.; 73% PC boards; high of $479,000 ann.; down 10%
Florida: Average: $225/hr., $397,000 ann.; 11% PC boards; high of $300/hr.; up 3%
Georgia: Average: $224/hr., $395,000 ann.; 44% PC boards; high of $300/hr.; down 8%
Louisiana: Average: $240/hr., $422,000 ann.; 50% PC boards; no highs; up 11%
Mississippi: Average: $258/hr., $451,000 ann.; 63% PC boards; high of $335/hr. (nights); no change
North Carolina: Average: $211/hr., $385,000 ann.; 13% PC boards; high of $450,000 ann.; no change
South Carolina: Average: $235/hr., $444,000 ann.; 29% PC boards; high of $500,000 ann.; up 7%
Tennessee: Average: $234/hr., $412,000 ann.; 40% PC boards; high of $520,000 ann.; no change

The Midwest has dipped just 3 percent, with an hourly/annual average of $210/$373,000, and 54 percent of jobs available are open to PC boards. Note the 16 percent raise in Kentucky incomes.

Illinois: Average: $222/hr., $392,000 ann.; 20% PC boards; high of $350/hr.; down 8%
Indiana: Average: $229/hr., $404,000 ann.; 53% PC boards; high of $480,000 ann.; up 8%
Iowa: Average: $184/hr., $332,000 ann.; 83% PC boards; high of $463,000 ann.; down 8%
Kansas: Average: $236/hr., $415,000 ann.; 25% PC boards; high of $450,000 ann.; up 7%
Kentucky: Average: $237/hr., $418,000 ann.; 69% PC boards; high of $503,000 ann.; up 16%
Michigan: Average: $175/hr., $315,000 ann.; 60% PC boards; high of $275/hr. (locums); down 10%
Minnesota: Average: $178/hr., $320,000 ann.; 70% PC boards; no highs; up 9%
Missouri: Average: $213/hr., $378,000 ann.; 51% PC boards; high of $275/hr., $380,000 ann.; down 9%
Nebraska: One employer offering $300/hr. (not factored into regional stats)
North Dakota: Average: $230/hr., $404,000 ann.; no PC boards; no highs; down 14%
Ohio: Average: $198/hr., $353,000 ann.; 57% PC boards; high of $300/hr. (locums); down 10%
South Dakota: No information
Wisconsin: Average: $213/hr., $377,000 ann.; 50% PC boards; high of $520,000 ann.; down 6%

The Southwest/West remains a wild ride, with an hourly/annual average of $208/$375,000, and 40 percent of jobs available are open to PC boards. It includes the state with the top compensation, Texas, and three of the lowest compensation states as well. Note, none of the highs are in major cities except in Texas.

Arizona: Average: $226/hr., $369,000 ann.*; 81% PC boards; no highs; no change
California: Average: $223/hr., $393,000 ann.*; 27% PC boards; high of $500,000 ann.; down 8%
Colorado: Average: $163/hr., $295,000 ann.; no PC boards; high of $200/hr.; up 8%
Hawaii: Average: $170/hr., $307,000 ann.; no PC boards; no highs; no change
Nevada: Average: $170/hr., $307,000 ann.; 28% PC boards; high of $300 hr. (locums); down 15%
New Mexico: Average: $234/hr., $412,000 ann.; 27% PC boards; no highs; up 4%
Oklahoma: Average: $193/hr., $346,000 ann.; 41% PC boards; high of $520,000 ann.; down 5%
Texas: Average: $260/hr., $454,000 ann.; 34% PC boards; high of $325/hr.; up 4%
Utah: No job openings
* major city averages considerably lower

The Middle Atlantic has no change from last year, with an hourly/annual average of $190/$340,000, and 24 percent of jobs available are open to PC boards.

Delaware: Only locum jobs averaging $240/hr.
District of Columbia: Average: $141/hr., $260,000 ann.; no PC boards; no highs; down 11%
Maryland: Average: $166/hr., $300,000 ann.; 11% PC boards; $75,000 sign-on; no change
New Jersey: Average: $186/hr., $333,000 ann.; 11% PC boards; no highs; down 8%
Pennsylvania: Average: $222/hr., $392,000 ann.; 23% PC boards; high of $515,000 ann.; up 3%
Virginia: Average: $230/hr., $405,000 ann.; 27% PC boards; high of $480,000 ann.; up 4%
West Virginia: Average: $195/hr., $349,000 ann.; 50% PC boards; no highs; up 3%

As usual, the Pacific Northwest remains on the low side, with an hourly/annual average of $182/$326,000, but note the significant drops in Montana and Washington.

Alaska: No information or jobs
Idaho: No information
Montana: Average: $165/hr., $300,000 ann.; no PC boards; no highs; down 25%
Oregon: Average: $180/hr., $325,000 ann.; 30% PC boards; no highs; down 5%
Washington: Average: $151/hr., $275,000 ann.; 50% PC boards; no highs; down 35%
Wyoming: Average: $230/hr., $405,000 ann.; 66% PC boards; $250,000 loan payback; down 4%

The Northeast also has little change, with an hourly/annual average of $176/$317,000. However, it has the lowest rate of PC board acceptance at only 8 percent.

Connecticut: Average: $179/hr., $322,000 ann.; no PC boards; no highs; down 3%
Maine: : Average: $179/hr., $322,000 ann.; 22% PC boards; no highs; no change
Massachusetts: Average: $180/hr., $323,000 ann.; no PC boards; high of $400,000 (Cape Cod); down 3%
New Hampshire: Average: $170/hr., $307,000 ann.; 14% PC boards; high of $200/hr.; down 10%
New York: Average: $156/hr., $285,000 ann.; 14% PC boards; high of $275/hr. (locums); down 9%
Rhode Island: No information
Vermont: Average: $191/hr., $341,000 ann.; no PC boards; no highs; no change

Figure 1. States Offering the Most and Least Compensation

Ms. Katz is president of The Katz Company EMC, a member of ACEP’s Workforce and Career sections, and a frequent speaker and faculty at conferences and residency programs. She can be reached at katzco@cox.net.