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.)

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