When I was a young recruiter in New York City, I spent many a summer weekend in the Hamptons, a string of small towns and hamlets along the eastern tip of Long Island. On any given Friday afternoon, as trains from Penn Station crammed with vacationers and packed like sardines with day-trippers in standing-room-only accommodations, the cacophony of voices and metal wheels shrieking against the rails was deafening. On one particular trip, there was a lull in the conversation, and I distinctly heard a lone voice exclaim, “Do you think there will be jobs when we get to America?” Of course, laughter exploded.

For the first time in the 32 years that I’ve worked in the emergency medicine arena, residents are asking, “Do you think there will be jobs when we get to graduation?” But this time, no one is laughing. The COVID-19 pandemic wreaked havoc on the specialty, with emergency department census levels dipping 42 percent overall early in the pandemic¹—and as much as 70 percent in some places. Physicians saw clinical hours cut back and salaries reduced; some were even laid off. The number of job opportunities for physicians dove well under 50 percent of 2019 levels, and some 2021 graduates left residency without a job. More than 75 percent of jobs were open to primary care boarded physicians, and there are reports of some employers replacing physicians with physician assistants and nurse practitioners to keep costs down.

So where is this pandemic train taking us?

In May 2021, I surveyed employers representing approximately 32 percent of the 8,600 emergency departments in the country and received about a 70 percent response rate. Employers ranged from small democratic groups to large national groups and included a strong percentage of teams employed directly by hospitals. The survey focused on both the past 2020–2021 and the upcoming 2021–2022 hiring seasons. Below are some highlights from these employers.

Current Workforce

Part one of the survey addressed current workforce status: 63 percent of respondents stated that their workforce numbers were the same as pre-COVID levels, and 37 percent reported their workforce was smaller. Staff reduction percentages ranged from 8 to 40 percent, with an average of 16 percent. Slightly more than 69 percent of employers have cut back on physician clinical hours, ranging from 5 to 30 percent, with an average of 15 percent.

On the compensation front, only 21 percent of respondents reported salary cuts for physicians, ranging from 5 to 20 percent, with an average of 12.5 percent. Some employers took steps to prevent cuts, including one large national group that had its leadership team take cuts so its physicians wouldn’t have to bear the brunt of the financial burden. The survey also asked about cuts to advances for new hires. Responses showed 68 percent experiencing no change and 32 percent cutting as much as half of the value of signing bonuses, loan forgiveness, relocation packages, and resident early sign-on stipends.

Next, the survey asked employers the percentage of primary care trained physicians on their workforce. Responses indicated higher levels than the pre-COVID period, with 58 percent having primary care boarded physicians, ranging from 5 to 100 percent of their staff, with an average of 32 percent of their workforce. Finally, the survey asked if employers had replaced any physicians with physician assistants and nurse practitioner—not a single employer who responded to the survey had done so.