The national average salary for emergency physicians increased again this past year, a full 3.5 percent. Not a stunning number, but when you add it into the trend of the past 10 years, it reflects a 34.5 percent increase for emergency physician salaries over the past 11 years.

How is it happening? States that have been chronically low-paying historically are starting to climb. In New York, for instance, starting salaries increased 25 percent this year. Even the West saw dramatic increases, with salaries up 32 percent in Nevada and 14 percent in New Mexico.

The Midwest continues to be all over the map, with increases in Michigan (11 percent), Minnesota (12 percent), and Ohio (14 percent) and a big decrease in Kansas of 18 percent. The Mid-Atlantic states experienced a 17 percent increase overall, including a 20 percent hike in the District of Columbia. The Pacific Northwest posted a 15 percent increase in Montana and 14 percent in Washington.

Another important number is the percentage of job opportunities open to physicians with primary care board certification (PC-BC). Currently, this is 43 percent! With nearly half the country’s emergency medicine jobs open to physicians not trained in emergency medicine, we have further evidence of the location-driven supply and demand market in the specialty. I see this number increasing in the next five years. You can also visit ACEP’s comprehensive archive of industry and EM-specific salary and compensation information.

Trends and developments this year include:

• Urgent care salaries are creeping up and, in some cases, pay as much or even more than emergency physician incomes in some states.
• Sign-on bonuses continue to grow, with $50,000 a norm and a high between $120,000 and $150,000 in geographically challenged areas.
• Broad salary ranges continue in some states, such as $116–$300 an hour in Pennsylvania and $160–$282 an hour in Minnesota.
• The highest dollars in emergency medicine occur in locum tenens offers, with the $300–$320 an hour appearing more frequently. I even found one location offering $350 an hour in North Dakota.
• Only eight states provide no options for PC-BC physicians this year.

The following numbers are based on working 1,632 clinical hours a 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 highs and lows.

The Southeast once again leads the country with a regional average of $236 per hour/$416,000 a year. It also nearly leads the country in opportunities open to physicians with PC-BC at 54 percent, up 26 percent from last year

Mississippi: Average: $265/hr., $463,000 ann.; 50% PC-BC; high of $300/hr.; no change South Carolina: Average: $253/hr., $444,000 ann.; 54% PC-BC; high of $500,000 ann.; up 7%
Georgia: Average: $238/hr., $418,000 ann.; 71% PC-BC; high of $300/hr.; up 6%
Tennessee: Average: $234/hr., $412,000 ann.; 75% PC-BC; no real highs; no change
Alabama: Average: $234/hr., $412,000 ann.; 25% PC-BC; high of $500,000 ann.; up 10%
North Carolina: Average: $228/hr., $402,000 ann.; 51% PC-BC; no real highs; up 8%
Arkansas: Average: $226/hr., $400,000 ann.; 100% PC-BC; no real highs; no change
Louisiana: Average: $225/hr., $397,000 ann.; 33% PC-BC; no real highs; down 7%
Florida: Average: $225/hr., $397,000 ann.; 25% PC-BC; high of $350/hr.; no change

The Southwest/West comes in second with a regional annual average of $220 per hour/$389,000 a year, up 10 percent from last year. Opportunities open to physicians with PC-BC are at 50 percent, up 8 percent.

New Mexico: Average: $271/hr., $472,000 ann.; 50% PC-BC; high of $533,000 ann.; up 14%
Nevada: Average: $248/hr., $434,000 ann.; 40% PC-BC; no real highs; up 32%
Texas: Average: $247/hr., $434,000 ann.; 43% PC-BC; high of $320/hr.; down 9%
California: Average: $228/hr., $402,000 ann.; 52% PC-BC; high of $520,000 ann.; no change
Arizona: Average: $218/hr., $386,000 ann.; 53% PC-BC; high of $500,000 ann.; no change
Oklahoma: Average: $203/hr., $362,000 ann.; 70% PC-BC; high of $500,000 ann.; no change
Hawaii: Average: $180/hr., $324,000 ann.; 0% PC-BC; no real highs; no change
Colorado: Average: $165/hr., $300,000 ann.; 40% PC-BC; high of $210/hr.; no change
Utah: No jobs open or information available

The 13 states of the Midwest have a $212 per hour/$377,000 a year regional average, with 52 percent of the jobs open to physicians with PC-BC.

North Dakota: Average: $233/hr., $410,000 ann.; 0% PC-BC; high of $350/hr. (locum tenens); no change
Illinois: Average: $232/hr., $408,000 ann.; 45% PC-BC; high of $500,000 ann.; up 5%
Ohio: Average: $231/hr., $407,000 ann.; 56% PC-BC; high of $312/hr.; up 14%
Kentucky: Average: $230/hr., $405,000 ann.; 66% PC-BC; high of $487,000 ann.; down 3%
Indiana: Average: $230/hr., $405,000 ann.; 50% PC-BC; no real highs; no change
Wisconsin: Average: $215/hr., $380,000 ann.; 53% PC-BC; high of $520,000 ann.; no change
Missouri: Average: $206/hr., $367,000 ann.; 52% PC-BC; no real highs; no change
Minnesota: Average: $201/hr., $358,000 ann.; 58% PC-BC; high of $489,000 ann.; up 12%
Michigan: Average: $196/hr., $350,000 ann.; 76% PC-BC; no real highs; up 11%
Iowa: Average: $195/hr., $348,000 ann.; 55% PC-BC; no real highs; up 6%
Kansas: Average: $193/hr., $344,000 ann.; 66% PC-BC; no real highs; down 18%
Nebraska: Average: $190/hr., $340,000 ann.; 45% PC-BC; no real highs; no change
South Dakota: No jobs open or information available

For the first time, the Pacific Northwest is fourth regionally instead of last, with an average of $200 per hour/$357,000 a year due to increases in Montana and Washington. PC-BC accep­tance is 62 percent, doubled from last year.

Wyoming: Average: $228/hr., $402,000 ann.; 64% PC-BC; no real highs; no change
Idaho: Average: $223/hr., $393,000 ann.; 66% PC-BC; high of $300/hr.; no past information
Montana: Average: $194/hr., $346,000 ann.; 25% PC-BC; no real highs; up 15%
Oregon: Average: $182/hr., $328,000 ann.; 52% PC-BC; no real highs; no change
Washington: Average: $175/hr., $315,000 ann.; 90% PC-BC; no real highs; up 14%
Alaska: No jobs open or information available

The seven Mid-Atlantic states come in under the national average at $198 per hour/$353,000 a year, with 29 percent of jobs open to PC-BC.

Virginia: Average: $243/hr., $426,000 ann.; 38% PC-BC; no real highs; up 3%
Pennsylvania: Average: $218/hr., $387,000 ann.; 50% PC-BC; high of $520,000 ann.; no change
New Jersey: Average: $204/hr., $362,000 ann.; 32% PC-BC; no real highs; up 9%
West Virginia: Average: $194/hr., $346,000 ann.; 60% PC-BC; no real highs; no change
Maryland: Average: $184/hr., $330,000 ann.; 25% PC-BC; no real highs; up 10%
District of Columbia: Average: $175/hr., $314,000 ann.; 0% PC-BC; no real highs; up 20%
Delaware: Average: $165/hr., $300,000 ann.; 0% PC-BC; high of $250/hr. (locum tenens); no change

In last place, the Northeast continues to drag its feet with a regional average of $186 per hour/$333,000 a year, despite the 25 percent hike in New York salaries. However, this region leads the country with the fewest opportunities for PC-BC at only 13 percent.

New York: Average: $208/hr., $370,000 ann.; 37% PC-BC; high of $479,000 ann.; up 25%
Massachusetts: Average: $186/hr., $333,000 ann.; 0% PC-BC; no real highs; no change
Vermont: Average: $184/hr., $330,000 ann.; 0% PC-BC; no real highs; no change
Maine: Average: $180/hr., $324,000 ann.; 25% PC-BC; no real highs; no change
Connecticut: Average: $179/hr., $322,000 ann.; 0% PC-BC; high of $275/hr. (locum tenens); no change
New Hampshire: Average: $178/hr., $320,000 ann.; 15% PC-BC; high of $400,000 ann.; no change
Rhode Island: No jobs open or information available

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. Contact her at katzco@cox.net.