[This is the second of a two-part series on the state of the emergency medicine job market. This installment focuses on compensation.]

The trend in compensation this season is essentially “more of the same.” What we saw last year was a direct result of the supply and demand marketplace, and nothing has changed there. What has changed are a few of the numbers.

There are actually fewer jobs overall than last season, possibly because there is a significant portion of last season’s jobs still unfilled. But the numbers are not as big. This reflects on the highs and lows. With no real standardization of income in the specialty across the country, the income numbers are strategically linked to the supply and demand for physicians. In areas where there are more emergency physicians with a strong lifestyle pull, the number of doctors available to fill open slots is considerably higher. Hence, the dollars needed to draw them are significantly lower.

In what I like to call “location-challenged” situations, where docs are less likely to want to live, the dollars can be significantly higher in order to encourage candidates to interview and accept positions. This is the norm. Exceptions exist but not many. For most of the past four years, there have been a few really high “highs” (topping $600K for a first-year doc) and some seriously scary lows, but I am finding fewer of those this season.

In general, the target income in the specialty is the magic $200 an hour. More and more employers in the Midwest, Southeast, parts of the West and now even the Middle Atlantic regions are reaching that number and even surpassing it.

Employers in most of the Northeast and Pacific Northwest are still hovering closer to a norm of $170 an hour. The lows across the country, primarily in highly desirable lifestyle areas and very rural regions, drop down to the $120 an hour range. The following overview is based on actual jobs available this season and, in general, a clinical schedule of 1,620 hours per year.

Bonuses, based either on RVU production or a combination of other factors, are included especially in the case of compensation programs based entirely on RVU production. These numbers are guidelines, not written in stone elements to be used when negotiating. At the top of the list in compensation are the 13 states of the Midwest. Wisconsin physicians earn the most with averages of $200 an hour and annual highs more than $500K. It is followed by Illinois and Iowa with averages in the $195 an hour and highs topping $293.

Ohio is back on track and catching up due to good incomes from Cleveland, Cincinnati and Columbus with an average of $193 an hour and highs more than $275 an hour that include strong sign-on bonuses. Indiana provided limited information, but the numbers ran about the same as Ohio. The Dakotas are middle of the pack with averages state-wide in the $190 hour range. Missouri is a state of contrasts with one group near Memphis offering $200 an hour plus $175K in loan assistance, full benefits, relocation, pension, etc. all topping $500K, and a low of $120 an hour in more rural areas. The average in Missouri is $180 an hour.

Kentucky provides a higher state-wide average at $185 an hour, but the incidental highs top out at $400K. Look for some good perks and higher sign-on bonuses there. Minnesota is also all over the place with annual lows of $240K in rural positions and average earnings state-wide of about $300K. Kansas was also low reporting but what numbers did appear were averaging $180 an hour. I only found a few spots open in Nebraska and the numbers looked like $140 an hour lows and $205 an hour highs. As usual, Michigan trails the pack, especially without the $200 an hour jobs usually found in Detroit that are absent this season. There are signs of increases however, with a few opportunities in that range outside the city.

How do I describe the compensation trends of the nine states in the West? Well, a total lack of information is a good start and it applies to Hawaii and Utah, which isn’t a serious problem because there aren’t jobs there anyway. In a different vein, Arizona has plenty of jobs but little information on earnings. The highest comp package I could find was in the $420K range in the western part of the state but averages in the highly desirable lifestyle areas of Maricopa County are closer to $150 an hour with CEP America exceeding that at their Sun City opportunities.

TeamHealth is also one of the few groups offering top dollar in California ranging from $190 to $225 an hour. California is the land of RVUs so absolutes and guarantees are hard to find. TeamHealth physicians are earning up to $195 an hour in the south, $220 an hour in the north and $175 an hour in the central part of the state. Averages are hard to calculate so suffice it to say that the more desirable the location, the lower the income and vice versa. Colorado is still averaging around $160 an hour with very little available in the way of perks except one employer offering bonuses to emergency physicians for admissions … must have missed that 60 Minutes episode!

The biggest bucks are to be found in RVU-heavy Texas, ranging from $200 to $245 an hour all over the state with the highest numbers in the southern border areas. Oklahoma and New Mexico also average $200 an hour this season but not in the more rural regions.

North Carolina leads the way in the Southeast with more highs including $275 an hour in Fayetteville and strong number all around the state averaging $185 an hour. On the flip side, Mississippi, which usually posts enormous highs, is pretty quiet this season with only one spot offering a $100K sign-on. Tennessee and South Carolina are providing averages in the $175-180 an hour range with highs reported between $225 and $250 an hour within RVU comp models. Louisiana has the widest ranges from $115 an hour to $220 an hour all site-specific; check in with Schumacher Group if you are looking in that area.

Florida numbers are stabilizing at the $175 an hour level with some highs outside of the larger cities more than $200 an hour. The same goes for Georgia, $170-210 an hour with the higher incomes based on RVU comp plans. Alabama averages $180 an hour in non-rural areas and Arkansas is non-reporting, though historically, it runs on par with Alabama.

It’s all about “pockets” in the seven Middle Atlantic states … little areas of high income like western Maryland, Tidewater, Va., and south-central to south-west Pennsylvania. Both Delaware and Washington, D.C. were virtually non-reporting but there is one lovely group in the beach resort area of Delaware offering close to $400K after a three-year path to partnership.

In Maryland, the big bucks are in Cumberland and Leonardtown at $350K plus some perks. Baltimore is averaging $280K to $300K annually, as are the Maryland burbs of D.C. Look for high incomes in Central P.A. and the Pittsburgh area with several openings offering high loan payback and income averages in the $210 an hour range.

Philly is the low point in Pennsylvania with incomes averaging $140-150 an hour. Virginia is a bit of a hodge-podge with $200 an hour in some Tidewater area opportunities and much lower averages elsewhere and in the Washington, D.C. suburbs. West Virginia has a few highs in the $200 an hour range and rural lows. Look for averages throughout the region of $160-170 an hour.

The seven states of the Northeast may as well be the land that time forgot when it comes to compensation. High cost of living meets low incomes! If you are looking in the region, start in Connecticut which offers partnership opportunities via EMP averaging $300K a year including strong pensions. Look for a state-wide average closer to $280K. The highest earning potential in Massachusetts is for a pediatric emergency physician at $200 an hour plus a full pension contribution. Otherwise, incomes average $300K annually in the east and a bit lower in the west. Boston averages $150 an hour. The upper tier New England states of Maine, Vermont and New Hampshire average $145 to $160 an hour with various benefits added. Nothing out of Rhode Island. Med-Excel continues to be the one shining beacon of income vs. cost-of-living ratios in New York with hourlies in the $165-175 range and even $200 an hour plus for their firemen.

The rest of the state averages $140-155 an hour with very few perks, though I did find one $350K job way upstate in the Buffalo region.

Because four of the six states of the Pacific Northwest are non-reporting, let’s talk about the other two, Oregon and Washington. Though I did find a position in Southwest Wyoming offering a $370K package, there is no reason to believe that reflects on the rest of the state. The principal employer in the Oregon/Washington corridor is TeamHealth’s Northwest Emergency Physicians. They have jobs in Portland and Seattle (but going fast, and possibly gone by the time this hits the presses) and income averages throughout both states range from $170 to $220 an hour, with the highs more prevalent as you move east.

Barb 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.