This is a year of change. Some trends, like the increase in opportunity for non-EM-trained physicians, are now on a downward spiral. Though the total number of job openings is slightly down from last year, the overall spread throughout the country has improved. You’ll find opportunity in places that rarely see a glimmer of activity, like San Diego, the Dakotas, Alaska, and even Charleston, South Carolina. There has been a meteoric rise in urgent care and locum tenens opportunities, including a fairly new locum tenens to permanent movement. A lot of the small regional groups, hospital employers, and larger national groups are opening freestanding satellite EDs. These sites are most often included in the rotation for their physicians, though some of these positions appear to be exclusive to the new site. This year’s “When Pigs Fly” award goes to my old favorite, Raleigh-Durham, North Carolina, or "The Research Triangle," as it is widely known. Pigs will be flying before a job turns up there!

Back in the 1990s when grandfathering was still allowed, primary care–trained physicians filled jobs all over the country. As the number of EM residency–trained physicians increased, the number of jobs open to primary care decreased, and eventually, toward the end of the century, we reached critical mass. Subsequently, hospitals closed and merged everywhere, the real estate market crashed, and physicians who would normally make moves didn’t because they couldn’t afford to sell their homes. In the early part of this century, the first crop of emergency physician graduates from the late '70s and '80s started retiring, and all of this added up to a candidate-driven job market with a serious shortage of physicians.

The rate of EM jobs open to non-EM-trained physicians is definitely trending down.

The rate of emergency medicine jobs open to physicians with primary care boards is definitely trending down from the high of 40 percent hit last year to 35 percent this year. Exclusive of jobs in rural areas and those at low-volume EDs (under 15,000), the rate goes down to 17.5 percent primary care board certification. While some physicians believe it is the contract management groups, which comprise 52 percent of the job market, that are keeping this trend alive, it is, in fact, the hospitals they serve. I spoke with Marcie Baker, an emergency physician recruiter with ApolloMD, and she assured me that the decision to accept primary care board certification from candidates lies solely in the hands of hospital clients and is often based on their bylaws. Most of these groups understand that until there are enough residency-trained and board-certified emergency physicians to go around in rural and less geographically desirable areas, they must remain flexible to fill their needs. One of the bigger players, TeamHealth, is providing a wide variety of clinical education, as well as leadership development and training programs to optimize the effectiveness of their physicians, according to Susan Masterson, TeamHealth’s national vice president of provider recruitment. Dan Culhane, MD, vice president of CEP America emphasized that leadership training is also a focus for his company. It offers both leadership and medical director academies, an administrative fellowship, and a host of committees that create higher levels of inclusion for their physician partners. Another national group, EMP, focuses on offering its physicians “a rich, tax-free benefits plan to enhance retirement funding and financial preparedness as well as stability and control,” said Ann Benson, EMP's vice president of recruiting. One thing is certain: there are not enough EM residency–trained physicians to fill the needs of the nation’s EDs, particularly in rural and less-popular geographic areas. Until that situation changes, opportunities for primary care physicians will remain strong.