I recently did a research project on the progression of emergency medicine residency programs in the past 20 years. There are now 200 residency programs broken down as follows: 114 three-year and 35 four-year Allopathic (total 149), 28 three-year and 18 four-year Osteopathic (total 46) and five military-based residency programs.

The yield from these residency programs is approximately 2,057 graduates, 1,727 Allopathic and 320 Osteopathic. With more than 1,500 new jobs being created each year and many leftovers still unfilled from the year before, the numbers just don’t add up. One of the major issues is also the location of these residencies with only 40 in the Western half of the US and the rest in the East. Many states tend to retain a large portion of their residents, but in states like North and South Dakota, the need is high and the supply low.

I recently had the pleasure of lecturing at the Regions Hospital Emergency Medicine Residency in St. Paul, Minn. Not one of their residents wanted to leave the state! In residency-rife cities like Philadelphia, Boston and New York, there is more of a migration from the program site (especially New York with their dismal income-to-cost ratios). But one-program states like Maine, Wisconsin and Oregon will retain more than 90% of their grads. Another factor is growth ratio … Allopathic program growth in the past five years is less than 7% while Osteopathic programs have increased by 20. All this means that there are not enough emergency physicians to fill the emergency departments and not enough emergency departments to handle the ever increasing census coming through their doors. So the market will be highly competitive again this year with fewer jobs in the highly-desirable lifestyle locations, and more in the rural and less popular lifestyle regions.

As for job requirements, we saw the availability of emergency medicine jobs open to primary care trained physicians hit a high of 35% last year. This year it is at 40%. These numbers have a direct correlation to permeation of large, national contract groups.

In the Northeast, where primary care boards are accepted at only 15% of jobs, only 22% of jobs are with NCGs.

In the Pacific Northwest where 70% of jobs are being offered by NCGs, 62% are open to PC boards. It is important to note that this situation cannot necessarily be laid at the feet of these groups. It is the administrators of the site hospitals who determine the board requirements of the emergency department physicians, not the groups. For instance, in New Jersey, with a heavy EmCare presence, only 3% of jobs accept primary care boards. I spoke with the primary EmCare recruiter in that region, and she confirmed that the requirements are set by the hospitals. So why track this element? It will make a strong difference as to whether job candidates will have a good chance of finding a peer group.

The 13 states of the Midwest lead the US with 27% of all available jobs, especially in Ohio. Look for strong opportunity all around Illinois, including Chicago, and EMP has a great new site with strong improvements in Springfield. You’ll also find lots to look at in Missouri, especially in the St. Louis area. In fact, if you are headed to the city of the arch, check in with CEP America for some new, hot partnership positions. Indiana and Wisconsin also have multiple openings, but not in any of their popular cities like Indianapolis, Madison or Milwaukee.

Iowa, Michigan, Minnesota and Kentucky all have moderate levels of opportunity, but again, not in their larger, more popular cities. Detroit is dead (and bankrupt) and whatever is showing up in the Twin Cities is being taken by their local grads. Kansas will have a few spots but are primarily NCG with 70% primary care boards accepted. The Dakotas are on the map this season with minor activity, but again, not in the larger cities. Nebraska has a few spots including Omaha via the Premier group.

Next up are the 10 states of the Southeast led by Florida, Georgia, North Carolina and Tennessee with a good level of opportunity in Nashville, Tampa and Charlotte but not so much in Atlanta or Miami. However, Team Health is offering jobs in Ft. Lauderdale as well as Tampa. And of course, the Raleigh/ Durham area remains virtually jobless. The Smokey & Blue Ridge Mountains area of Tennessee and North Carolina are also pretty open this year if you have an interest there.

South Carolina offers some suburban opportunity along with one job in Charleston and one in Hilton Head, both of which will probably be gone in a flash. Alabama, Arkansas, Mississippi and Louisiana are more on the moderate side, though Birmingham will have a few spots. New Orleans is very quiet. The region is 60% open to primary care boards except in North Carolina where only 22% of jobs don’t require emergency medicine training.

The West is led by Texas as usual with a broad level of activity throughout, including Dallas, Houston and especially in the San Antonio and Austin areas. About half the jobs in Texas are open to primary care boards. California and Texas represent 75% of the jobs open in the West. Look for lite opportunity in the San Francisco Bay area and Los Angeles, but nothing in San Diego. Your best bet if you are looking in the Sacramento or Central Valley is CEP America. Phoenix is jumping in Arizona, some via Team Health, and Oklahoma City has opportunity as well.

Both of those states also have about 50% primary care board approval, as do the one or two jobs in Hawaii. New Mexico is primarily southern region opportunity with one or two jobs in the Albuquerque area. Nevada is all about Las Vegas. There are a few jobs in Colorado, primarily eastern and rural, and Utah is pretty quiet as usual. Opportunity runs pretty evenly throughout the Middle Atlantic with strong opportunity in Philadelphia, Richmond and the DC/Baltimore metro areas.

Virginia and Maryland are offering a broad spectrum of jobs around both states and Pennsylvania’s jobs are scattered all over except for lighter opportunity in the west. Look for one or two spots in Delaware, but New Jersey is a better bet, especially in the NYC Metro area. West Virginia has some good opportunity in the smaller cities and the Charleston area. Only 15% of the jobs in this region are open to primary care boards.

The seven states of the Northeast are also primarily closed to primary care boards with only 15% availability. New York is offering jobs in and around the NYC metro area and the central part of the state. Massachusetts and Connecticut have moderate opportunity including a good bit of academic in the Boston area. Rhode Island’s jobs are mostly in Providence, but the positions open in Maine are more rural. New Hampshire’s positions are in the center and southern areas and there are one or two spots in Vermont.

Only 4% of the US jobs will be in the Pacific Northwest, mostly in Washington and Oregon.

Little is looming in Seattle, except for one of two slots with Team Health, but the surprise of the season is the appearance of job openings in Portland. Wyoming is opening up this year as well but only a smattering of rural opportunity exists in Montana and Idaho. Alaska, ah the wilderness … maybe next year! The region has 70% large, national contract group employers, and 62% openings for primary care boards (except for Wyoming, which is only 15%).

And finally, the When Pigs Fly Award for the 2013/14 season goes to … Raleigh/Durham! Don’t be fooled by job listings claiming to be “near” the research triangle … unless you define “near” as more than an hour away.

Ms. Katz is the owner of The Katz Company EMC Inc., an emergency medicine consulting and recruitment firm. She has been writing about emergency medicine careers and teaching effective job searching to residents for nearly 20 years. She can be reached at katzco@cox.net.

[Editor’s note: This is the first of a two-part series on the job market. This installment focuses on location.]