SPECIAL CONTRIBUTION. Abstract. Susan H. Watts, PhD, Susan B. Promes, MD, and Robert Hockberger, MD

Transcription

1 SPECIAL CONTRIBUTION The Society for Academic Emergency Medicine and Association of Academic Chairs in Emergency Medicine Emergency Medicine Faculty Salary and Benefits Survey Susan H. Watts, PhD, Susan B. Promes, MD, and Robert Hockberger, MD Abstract Objectives: The objective was to report the results of a survey conducted jointly by the Society for Academic Emergency Medicine (SAEM) and the Association of Academic Chairs in Emergency Medicine (AACEM) of faculty salaries, benefits, work hours, and department demographics for institutions sponsoring residency programs accredited by the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Emergency Medicine (RRC-EM). Methods: Data represent information collected for the academic year through an electronic survey developed by SAEM and AACEM and distributed by the Office for Survey Research at the University of Michigan to all emergency department (ED) chairs and chiefs at institutions sponsoring accredited residency programs. Information was collected regarding faculty salaries and benefits; clinical and nonclinical work hours; sources of department income and department expenses; and selected demographic information regarding faculty, EDs, and hospitals. Salary data were sorted by program geographic region and faculty characteristics such as training and board certification, academic rank, department title, and sex. Demographic data were analyzed with regard to numerous criteria, including ED staffing levels, patient volumes and length of stay, income sources, salary incentive components, research funding, and specific type and value of fringe benefits offered. Data were compared with previous SAEM studies and the most recent faculty salary survey conducted by the Association of American Medical Colleges (AAMC). Results: Ninety-four of 155 programs (61%) responded, yielding salary data on 1,644 faculty, of whom 1,515 (92%) worked full-time. The mean salary for all faculty nationwide was $237,884, with the mean ranging from $232,819 to $246,853 depending on geographic region. The mean salary for first-year faculty nationwide was $204,833. Benefits had an estimated mean value of $48,915 for all faculty, with the mean ranging from $37,813 to $55,346 depending on geographic region. The following factors are associated with higher salaries: emergency medicine (EM) residency training and board certification, fellowship training in toxicology and hyperbaric medicine, higher academic rank, male sex, and living in the western and southern regions. Full-time EM faculty work an average of 20 to 23 clinical hours and 16 to 19 nonclinical hours per week. Conclusions: The salaries for full-time EM faculty reported in this survey were higher than those found in the AAMC survey for the same time period in the majority of categories for both academic rank and geographic region. On average, female faculty are paid 10% to 13% less than their male counterparts. Full-time EM faculty work an average of 20 to 23 clinical hours and 16 to 19 nonclinical hours per week, which is similar to the work hours reported in previous SAEM surveys. ACADEMIC EMERGENCY MEDICINE 2012; 19: ª 2012 by the Society for Academic Emergency Medicine From the Department of Emergency Medicine, Texas Tech University Health Sciences Center, Paul L. Foster School of Medicine (SHW), El Paso, TX; the Department of Emergency Medicine, University of California San Francisco Medical Center (SBP), San Francisco, CA; and the Department of Emergency Medicine, Harbor-University of California Los Angeles Medical Center (RH), Torrance, CA. Received April 8, 2012; revision received April 10, 2012; accepted April 10, Financial support for the development and dissemination of the electronic survey was provided by the boards of directors of SAEM and the AACEM. None of the authors have any financial arrangements or conflicts of interest to disclose. Supervising Editor: David C. Cone, MD. Address for correspondence and reprints: Susan H. Watts, PhD; susan.watts@ttuhsc.edu. ISSN ª 2012 by the Society for Academic Emergency Medicine 852 PII ISSN doi: /j x

2 ACADEMIC EMERGENCY MEDICINE July 2012, Vol. 19, No The Society for Academic Emergency Medicine (SAEM) has conducted salary surveys seven times over the past 20 years because of concerns that the salary surveys conducted by the Association of American Medical Colleges (AAMC) may not accurately represent the salaries of many academic emergency physicians (EPs). 1 4 The AAMC salary survey is limited to university-based programs where EPs may or may not be involved in emergency medicine (EM) resident education, in addition to medical student education. Another limitation is that the AAMC does not collect salary information for those employed by privately or publicly funded programs. The SAEM surveys are conducted to obtain salary and benefit information for all EPs involved in EM resident education, whether or not their residency programs are based at medical schools. The surveys also collect information regarding work duties and hours, research funding, and emergency department (ED) and hospital demographics. The current survey was conducted by SAEM in collaboration with the Association of Academic Chairs in Emergency Medicine (AACEM). METHODS Study Design and Population This cross-sectional study reports salary and demographic data for fiscal year It was reviewed by the institutional review board for the Texas Tech University Health Sciences Center Paul L. Foster School of Medicine and was provided an exempt status. Department chiefs, chairs, and administrators from all of the EM residency programs approved by the Accreditation Council for Graduate Medical Education (ACGME) Residency Review Committee for Emergency Medicine (RRC-EM) received an electronic SAEM salary survey link via . Survey Content and Administration In the past, a paper survey form was used, and the response rate had degraded over the years. This current project employed Vovici EFM Continuum Professional Edition electronic survey software to administer the survey (Verint Systems Inc., Melville, NY), which retained the majority of the old questions and added new ones based on input from the SAEM Faculty Development Committee and representatives of AACEM. All changes were reviewed and approved by the SAEM Board of Directors and AACEM leadership. The Office for Survey Research at the University of Michigan was contracted by the SAEM board to create the electronic document, distribute it to the chairs of the 155 RRC-approved programs, and then compile and report the survey data back to the board. This electronic format has the capacity for chairs or administrators to retrieve their previously reported information, which will facilitate the completion of future surveys. It is anticipated that this ability to readily review and update information should improve the response rate in the future. The survey was sent out twice in June 2010 and July 2010, and several requests for participation were disseminated on the AACEM list serve. The chairs were asked to provide demographic information about their programs and associated hospitals and to include salary data for all faculty whose compensation was derived at least 50% from EM resources. Excluded were those working less than 50% full-time equivalent, house staff, and fellows. Also excluded as sources of compensation for this study were honoraria, royalties, National Institutes of Health service, consulting fees, and moonlighting outside the institution. The Office for Survey Research at the University of Michigan coded and compiled the information from completed electronic survey forms into spreadsheets and then sent the final version to the SAEM board, which subsequently provided the files to the authors for analysis. The authors were blinded to the names of any individual faculty members and were able to identify individual programs by region only. Measurements Compensation and work-related data included: Base salary: defined as the portion of salary that is fixed or guaranteed by the department, institution, or practice plan. It does not include fringe benefits or practice earnings. Expected nonguaranteed component: defined as compensation that is not guaranteed beyond the current salary period, such as a stipend for an administrative role. This category also includes perhour compensation based on the number of hours worked, but not guaranteed, month to month. Bonus and incentive earnings: defined as funds derived from any combination of year-end bonus, incentive earnings, or outside earnings controlled by the institution or practice plan. Total expected earnings: derived from the sum of base salary, estimated nonguaranteed component, and bonus and incentive components. Estimated cash value of fringe benefits: entered as a dollar amount rather than as a percentage of salary. Clinical hours: defined as the average number of weekly hours worked in a clinical arena seeing patients and supervising residents who are seeing patients. Nonclinical hours: defined as the average number of weekly hours devoted to administrative duties, research, lecture preparation, lecture delivery, grand rounds, staff meetings, etc. Physician, ED, and hospital demographic data included: Physician sex, training and certification, years of experience, academic appointment, primary nonclinical duties, and whether they were core or non-core faculty as defined by the ACGME for EM residencies. 5 Sources of ED income, ED expenses, and amount and sources of research support. ED census; presence of separate pediatric, lowacuity, and observation areas; patient throughput times; and percentage of patients admitted. Hospital type by funding source and number of intensive care unit (ICU) and non-icu beds. The program s AAMC region. 6 Data Analysis The data were provided to the authors as Excel spreadsheets. All analyses were performed using Stata (v10.1,

3 854 Watts et al. SAEM-AACEM SALARY AND BENEFITS SURVEY StataCorp, College Station, TX). Data for previous surveys were available only from previously published results. The authors did not have access to raw data, so tests for statistical significance between years were not performed. RESULTS Ninety-four of the 155 RRC-approved EM residency programs (61%) completed the survey. This response rate is an improvement over the 46% for the previous survey and similar to the two prior surveys (see Data Supplement S1, available as supporting information in the online version of this paper). Information for 1,728 faculty was submitted, and salary information was provided for 1,644 (95%), of whom 1,515 were considered full-time (averaged at least 28 hours per week). Seventy-eight programs provided detailed compensation information and 16 programs provided demographic information only. This survey, compared to the AAMC salary survey, provides an alternate perspective of the current compensation and demographics for Table 1 Comparison of Faculty Demographics for Last Four SAEM Salary Surveys Demographic (n =1,728) (n =1,213) (n =1,355) (n =1,032) Years of experience At present position 8.6* Since residency Sex Male 1,183 (68)* 897 (74) 987 (76) 809 (78) Female 528 (31) 313 (26) 314 (24) 223 (22) Tenure Tenured 175 (10) 81 (7) 108 (8) 78 (8) Nontenured 1,447 (84) 1,084 (89) 1,180 (87) 929 (90) Fixed-term 52 (3) NA NA NA Not reported 37 (2) 48 (4) 67 (5) 25 (2) Degree MD 1556 (90) 1149 (95) 1290 (95) 974 (94) DO 85 (5) 46 (4) 62 (5) 55 (5) PhD or other (PhD only 2009) 8 (0.5) 72 (5) 61 (5) 29 (3) MD PhD 26 (2) NA NA NA MA MS 3 (0.2) NA NA NA Other 6 (0.3) NA NA NA Not reported 27 (2) 18 (1) 3 (0.2) 3 (0.3) Training and certification EM residency-trained 1,501 (87) 1,006 (83) 1,061 (78) 712 (69) ABEM- or AOBEM-certified 1,473 (85) 964 (79) 1,108 (82) 838 (81) Other board-certified NA 292 (24) 373 (28) 342 (33) Fellowship-trained 221 (13) 270 (22) 243 (18) 120 (12) Academic appointment Full professor 169 (10) 107 (9) 103 (8) 54 (5) Associate professor 388 (22) 238 (20) 216 (16) 144 (14) Assistant professor 935 (54) 685 (56) 768 (57) 611 (59) Instructor 161 (9) 129 (11) 146 (11) 122 (12) Adjunct professor 5 (0.3) NA NA NA Primary duties reported Chair 78 (5) 55 (5) 70 (5) 67 (6) Assistant chair 60 (3) 41 (3) 52 (4) 46 (4) Chair and residency director 4 (0.2) 3 (0.2) 8 (1) 8 (1) Residency director 72 (4) 55 (5) 65 (5) 67 (6) Assistant residency director 105 (6) 84 (7) 77 (6) 64 (6) Clinical director 78 (5) 46 (4) 54 (4) 35 (3) Director, pediatrics 25 (1) 26 (2) 30 (2) 24 (2) Director, low-acuity area 7 (0.4) 11 (1) 21 (2) 9 (1) EMS director 61 (4) 48 (4) 60 (4) 60 (6) Research director 61 (4) 39 (3) 61 (5) 55 (5) Toxicology director 26 (2) 20 (2) 28 (2) 20 (2) Quality assurance director 22 (1) 25 (2) 29 (2) 34 (3) Fellowship director 39 (2) NA NA NA Medical student clerkship director 63 (4) NA NA NA Ultrasound director 47 (3) NA NA NA Staff, clinical duties only 351 (20) 276 (23) 267 (20) 126 (12) Staff, clinical and admin duties 516 (30) 419 (35) 459 (34) 371 (36) Staff, pediatrics only 52 (3) 50 (4) 53 (4) 35 (3) Staff, low-acuity area only 6 (0.3) 7 (1) 19 (1) 11 (1) *Data are reported as mean or n (%). ABEM = American Board of Emergency Medicine; AOBEM = American Osteopathic Board of Emergency Medicine; NA = not applicable, questions not asked in previous years; SAEM = Society for Academic Emergency Medicine.

4 ACADEMIC EMERGENCY MEDICINE July 2012, Vol. 19, No EPs, as only 43 of 94 programs (46%) were certain that their salary data had been provided to the AAMC for their salary survey; 4% of programs did not provide information to AAMC, 46% did not know, and 4% did not answer this question (see Data Supplement S2, available as supporting information in the online version of this paper). Compared to the previous survey, the percentage of programs reporting to the AAMC increased (46% vs. 41%), but the percentage of programs that did not know if their salaries had been reported to the AAMC also increased (46% vs. 36%). The demographics of the reported faculty are changing in some respects over time. The percentage of female faculty has slowly increased from 22% in 1998 up to 31% in the current survey (Table 1). Also of note is that the percentage of EM residency trained faculty has increased over the past 20 years, from 69% in 1998 to 87% in The mean number of years at present position (8.6 years) and since residency (11.8 years) is greater in the current survey than in previous years. This may be related to the increase in the percentage of faculty who are at higher academic ranks (full professors 10%, associate professors 22%). The vast majority of faculty continue to be nontenured (84%); however, the percentage of tenured faculty increased to 10% in the current survey, up from 6.7% in The percentages of faculty who hold various departmental positions appear to have changed little over 20 years. Salary and Benefits The mean salary and benefits for all EM faculty nationwide in 2009 were $237,884 and $48,915, respectively. The highest mean salaries were documented for those working in the west ($246,853) and the lowest to those working in the northeast ($232,819) regions of the United States. Since the survey, the mean annual salary for faculty has increased by more than $50,000 both for faculty in general and for those in their first year at an academic institution (Table 2). Mean salaries vary by AAMC region in any given year, but have increased over time within each region. Similarly, the dollar amount of the mean benefits package has increased at each survey time point. However, since the last survey ( ), many programs report that they are no longer offering several types of fringe benefits (Data Supplement S3, available as supporting information in the online version of this paper). The most notable changes are for paid educational leave and funding for faculty research. In 2004, 84% of programs reported providing paid annual leave for education. Five years later, only 54% of programs reported that benefit. Similarly, the number of programs providing funds for faculty research dropped from 83% to 60%. The types of productivity that are considered for faculty compensation have not changed appreciably over 20 years (Data Supplement S4, available as supporting information in the online version of this paper). The percentage of programs reporting that they take into account clinical, research, and educational productivity varies only slightly from survey to survey. For the current survey, new information about clinical productivity was compiled from questions Table 2 Multiyear Comparisons of Full-time* Faculty Salaries Year Total Faculty Mean Salary about relative value units (RVUs). Forty-one programs reported that RVUs are expected, but only 31 reported the actual values they consider. Eleven programs reported having RVU-based salaries and 26 said they have RVU-based bonuses. Expected RVUs ranged from 2 to 9.9 (average = 6.4), suggesting that programs calculate RVUs differently. Some programs appear to limit RVU calculations to patients seen solely by the faculty physician, while others combine the patients of the faculty with those of the residents and students they are supervising. SD Mean Benefits All faculty ,515 $237,884 $65,221 $48, ,213 $189,848 $51,220 $40, ,355 $180,913 $49,506 $35, $166,503 $45,367 $29, ,032 $158,100 $29,144 $41, $139,963 $48,222 $32, $124,986 $34,057 $31,008 First-year faculty $204,833 $44,708 $45, $153,855 $36,938 $32, $147,746 $31,715 $29, $139,656 $28,310 $27, $131,074 $25,159 $35, $124,815 $27,939 $27, $93,617 $22,509 $22,374 By AAMC regions Northeast $232,819 $59,076 $55, $192,864 $49,562 $45, $178,593 $48,673 $38, $166,726 $43,650 $30, $155,909 $36,086 $36, $132,575 $33,760 $38, $118,083 $33,125 $8,355 South $242,808 $68,111 $46, $182,768 $52,382 $35, $176,314 $50,391 $29, $147,822 $41,379 $27, $155,403 $38,243 $38, $142,234 $33,071 $30, $125,098 $34,058 $21,297 Midwest $236,318 $55,919 $46, $192,224 $51,792 $40, $200,095 $47,842 $36, $195,195 $44,483 $33, $172,260 $48,138 $48, $154,940 $70,361 $30, $135,674 $35,838 $42,650 West $246,853 $85,871 $37, $195,732 $49,041 $42, $166,779 $44,577 $29, $148,990 $37,404 $24, $139,930 $32,938 $32, $128,020 $28,275 $29, $114,634 $26,294 $24,400 AAMC = Association of American Medical Colleges. *For full-time was defined as at least 28 hours per week.

5 856 Watts et al. SAEM-AACEM SALARY AND BENEFITS SURVEY Inequalities Between Salaries of Men and Women Comparison of the average salaries of men and women revealed that inequalities persist. Women continue to be paid less than their male colleagues. When stratified by academic rank and region of the country, the average salary for women was lower than for men at all academic ranks and in all areas of the country, except associate and full professor in the west (Table 3). Similarly, when comparing the salaries of men and women by departmental positions, women are paid less than men in 14 of 16 positions (Table 4). The largest differences are seen between men and women who were quality assurance directors or poison center toxicology directors where salaries for females in these positions are 82% of their male counterparts. Female department chairs are paid 11% less on average than their male counterparts. Salaries for women exceed those of men in only two positions: fellowship directors and ultrasound directors (details by region are not shown due to the potential to identify individuals). Stratifying average salaries for men and women by core and noncore status revealed that, on average, core faculty are paid more than noncore faculty whether male or female (Table 5). However, female faculty are paid 10% to 13% less than their male counterparts whether they are core or noncore faculty. Training Another factor influencing salaries is training. In general, those with fellowship training in pediatric EM have average salaries that are less than those reported for all respondents (Table 6). In contrast, average salaries for those with toxicology or hyperbaric medicine fellowship training are greater than the average reported faculty salary at all academic ranks. Faculty who are EM residency-trained, rather than non EM residency-trained, are paid more at all academic ranks except full professor. Similarly, EM-boarded faculty have higher average salaries at the ranks of assistant and associate professor. Faculty with DO degrees appear to have higher average salaries than their MD colleagues, but this could be due to differences in regional salaries and distribution. Sources of Income Income to support salary expenditures and other departmental functions comes from several sources. The primary source of income for 63% of programs was reported to be professional fees, while the program s associated hospital was the primary source of income for 21% of programs (see Data Supplement S5, available as supporting information in the online version of this paper). Seventy-three of 79 programs (92%) reported that at least 50% of their income was derived from clinical revenue (data not shown). Research funding is an additional source of funding and 18 programs reported they had received over $1 million of research funding from all sources (see Data Supplement S6, available as supporting information in the online version of this paper). From these various sources of income, 82% of programs reported that at least 50% of their annual budget was expended on physician salaries and benefits (see Data Supplement S7, available as supporting information in the online version of this paper). Malpractice expenses were under 20% for all programs, and the majority of programs (91%) had education expenses that were <20% of total annual expenses. Hospital Volume and Staffing Patterns The hospitals associated with each program vary widely in their annual patient volumes and numbers of ICU beds (see Data Supplement S8, available as supporting Table 3 Salary by Sex, Academic Rank, and Region ( ) Salary, All Female Salary n (%) Male salary n (%) Difference Between Salaries Instructor $199,786 $195, (41) $202, (59) $7,774 Midwest $194,531 $189, (42) $198, (58) $9,045 Northeast $204,177 $198, (44) $208, (56) $9,273 South $192,554 $190,687 4 (29) $193, (71) $2,613 West $198,744 None 0 $198,744 2 (100) Assistant professor $228,034 $214, (33) $234, (67) $19,703 Midwest $232,111 $221, (29) $236, (71) $15,228 Northeast $226,725 $211, (34) $234, (66) $23,325 South $229,455 $217, (33) $235, (67) $17,292 West $221,914 $209, (37) $229, (63) $19,408 Associate professor $246,912 $231, (25) $252, (75) $20,573 Midwest $244,367 $232, (23) $247, (77) $15,674 Northeast $246,942 $219, (25) $256, (75) $36,791 South $245,360 $229, (25) $250, (75) $21,256 West $251,916 $254, (28) $251, (72) $3,108 Full professor $312,592 $282, (12) $316, (88) $33,727 Midwest $312,154 * 1 (4) $313, (96) Northeast $334,019 $287,497 3 (8) $338, (92) $50,751 South $328,689 $237,880 3 (8) $336, (92) $98,822 West $287,952 $295, (20) $286, (80) $9,198 *Not shown because identifiable.

6 ACADEMIC EMERGENCY MEDICINE July 2012, Vol. 19, No Table 4 Salary by Sex, Departmental Position, and Region ( ) Position All Faculty Female Male Difference Between Male and Female Salaries Chair or chief of department $375,916 $339,873 $379,144 $39,271 Midwest $363,639 Northeast $399,847 South $378,512 West $342,814 Assistant vice chair $282,070 $272,082 $284,108 $12,026 Midwest $287,908 Northeast $297,342 South $269,263 West $252,662 Residency director $253,394 $231,343 $259,447 $28,104 Midwest $236,302 Northeast $260,944 South $256,373 West $252,515 Associate assistant residency director $235,006 $223,371 $244,917 $21,546 Midwest $236,298 Northeast $229,740 South $240,896 West $238,994 Medical student clerkship director $228,671 $218,218 $234,886 $16,668 Midwest $222,299 Northeast $214,952 South $233,146 West $268,057 Fellowship director $223,535 $228,827 $221,183 $7,644 Midwest $218,071 Northeast $210,294 South $232,140 West $243,070 Research director $233,068 $223,439 $235,580 $12,141 Midwest $218,615 Northeast $255,879 South $235,165 West $205,508 Quality assurance director $246,049 $210,796 $262,501 $51,705 Midwest $173,250 Northeast $233,217 South $253,225 West $273,580 Clinical director $259,044 $223,860 $266,796 $42,936 Midwest $250,026 Northeast $258,191 South $278,408 West $247,638 Director pediatrics $250,430 $230,391 $268,799 $38,408 Midwest $228,667 Northeast $226,425 South $249,232 West $303,122 Director EMS $240,947 $232,483 $242,787 $10,304 Midwest $236,905 Northeast $229,890 South $250,195 West $254,022 Poison center toxicology director $254,308 $221,432 $267,093 $45,661 Midwest $190,000 Northeast $234,106 South $277,345 West $345,667 Ultrasound director $245,148 $257,833 $240,238 $17,595 Midwest $242,822 Northeast $237,257 South $254,924 West $280,667

7 858 Watts et al. SAEM-AACEM SALARY AND BENEFITS SURVEY Table 4 (Continued) Position All Faculty Female Male Difference Between Male and Female Salaries Staff clinical and administrative duties $223,468 $215,170 $227,078 $11,908 Midwest $225,719 Northeast $218,780 South $224,334 West $233,945 Staff clinical duties only $220,098 $210,539 $224,514 $13,975 Midwest $227,234 Northeast $215,984 South $203,134 West $233,623 Staff pediatrics only $182,802 $176,749 $195,773 $19,024 Midwest $192,395 Northeast $176,855 South $186,643 West $184,714 Table 5 Salaries of Core and Noncore Faculty by Sex Faculty Type Female n Male n Core $223, $253, Noncore $207, $229, information in the online version of this paper). Fortythree programs reported having observation units, with 60% of them seeing less than 2,500 patients per year and 15% treating more than 5,000 patients per year. Seventy-two of 94 programs (77%) reported having low-acuity areas in their EDs (not shown). The number of patients seen in the low-acuity areas was calculated as a percentage of total ED volume, and the values ranged from 2% to 36%. The average was 17.7%, which is markedly lower than the 26% reported in The percentage of low-acuity visits appears to have no relationship to the annual ED volume. As seen in Data Supplement S9 (available as supporting information in the online version of this paper), hospitals with 50,000 patients per year, for example, ranged from having as few as 2% of patients seen in a low-acuity area up to over a third of patients (36%) cared for in this type of unit. Similarly, patient length of stay in the ED appears to have little relationship to annual patient volume; 85% of programs reported their average length of stay for all patients as less than 6 hours despite total annual patient volumes ranging from 30,000 to >120,000; 95% reported stays for discharged patient of less than 6 hours, while 86% of admitted patients stayed 9 hours or less (see Data Supplement S10, available as supporting information in the online version of this paper). Admission rates in past surveys have averaged about 22%. Rather than calculating an average admission rate for all hospitals, the present survey obtained data about admissions using ranges. Fifty-four of 91 programs (59%) had admission rates of 20% 29% and 15 programs (28%) reported >30% admissions (Data Supplement S8). Hospitals reported varying strategies for ED staffing. When comparing hospitals with similar annual patient volumes, the types of providers and their hours of coverage vary widely (see Data Supplement S11, available as supporting information in the online version of this paper). For example, of the 12 hospitals with annual volumes of 60,000 patients, five reported 25 to 49 hours of physician coverage per day (i.e., up to double coverage around the clock), three reported up to triple coverage around the clock (50 to 74 hours per day), and four programs reported three to four physicians in the ED around the clock (75 to 99 hours per day). Seventy-five percent of programs reported having coverage by physician assistants, and 74% of programs reported coverage by nurse practitioners. Typically there are two to four EM residents around the clock, and programs with EM fellows reported daily coverage from them as well. Hours Worked In previous years, clinical and nonclinical hours were reported as the total number of hours per year, which were averaged to calculate hours per week. For the current survey, this information was collected as ranges of hours per week. In , mean clinical and nonclinical hours per week were reported as 22 and 21, respectively. In the present survey, the findings were similar, with the median range of clinical hours being 20 to 23 hours per week and the median range of nonclinical hours being 16 to 19 hours per week (see Data Supplement 12, available as supporting information in the online version of this paper). Comparison to AAMC salary information Comparing the results of this survey to the AAMC Salary Survey for the same time period ( ), 6 we find that for the majority of the 16 categories (four academic ranks in four regions), mean salaries reported by the AAMC are lower than the average salaries reported in this survey (Table 7). The largest differences occur in all ranks in the western region, with salary differences ranging from $13,000 to $50,000, depending on rank. At

8 ACADEMIC EMERGENCY MEDICINE July 2012, Vol. 19, No Table 6 Salaries by Academic Rank Comparing Those Who Are Fellowship-trained, EM Residency-trained, ABEM- or AOBEMcertified, DO MD Training Instructor Assistant Professor Associate Professor Full Professor All salary for all full-time faculty $215,808 $219,699 $245,717 $336,447 $238,519 Fellowship-trained Toxicology (n =58) $217,000 $222,209 $257,313 $345,784 $255,263 Pediatrics (n =121) $171,616 $207,022 $228,740 $326,875 $219,350 Sports medicine (n =14) $256,000 $220,010 $239,308 None $225,036 Hyperbaric undersea (n =20) $350,000 $272,750 $322,885 $347,000 $297,927 Residency type EM (n =1501) $200,264 $229,462 $250,506 $308,767 $238,925 Non-EM (n =188) $196,401 $215,356 $217,020 $332,452 $239,306 ABEM or AOBEM certification Yes (n =1473) $200,553 $229,592 $249,129 $315,798 $241,022 No (n =161) $206,203 $219,334 $218,770 $322,610 $228,601 Medical degree type MD (n =1582) $199,378 $227,039 $248,561 $315,110 $242,774 DO (n =85) $220,944 $243,189 $264,923 * $245,206 ABEM = American Board of Emergency Medicine; AOBEM = American Osteopathic Board of Emergency Medicine. *Identifiable due to low number. Table 7 Comparison of AAMC and SAEM-AACEM Salaries. the rank of full professor, AAMC mean salaries are $17,000 to $53,000 lower than in the SAEM survey, depending on region. DISCUSSION SAEM-AACEM Salary AAMC Salary Difference Instructor $199,786 $197,400 $2,386 Midwest $194,531 $217,800 $23,269 Northeast $204,177 $196,300 $7,877 South $192,554 $155,000 $37,554 West $198,744 $148,500 $50,244 Assistant professor $228,034 $228,100 $66 Midwest $232,111 $236,300 $4,189 Northeast $226,725 $229,300 $2,575 South $229,455 $225,300 $4,155 West $221,914 $208,600 $13,314 Associate professor $246,912 $251,100 $4,188 Midwest $244,367 $253,000 $8,633 Northeast $246,942 $263,300 $16,358 South $245,360 $242,100 $3,260 West $251,916 $237,300 $14,616 Full professor $312,592 $275,300 $37,292 Midwest $312,154 $258,500 $53,654 Northeast $334,019 $288,600 $45,419 South $328,689 $284,700 $43,989 West $287,952 $271,400 $16,552 AACEM = Association of Academic Chairs in Emergency Medicine; AAMC = Association of American Medical Colleges; SAEM = Society for Academic Emergency Medicine. This survey indicates that average annual salaries for academic EPs increased by $40,000 to $50,000 between 2004 and 2009 in all regions. In general, this survey also indicates that salaries are higher for many physicians in academic practice than what is reported in the AAMC survey for Demographic data from the survey indicate that physicians are staying in academic practice for longer periods of time as indicated by their time at present positions and time since completing residency. This trend is also supported by the increased percentages of faculty who are advancing to higher academic ranks. Perhaps this may be partially due to the improved salaries since the last survey. This survey also demonstrates that EM residency programs have increasing numbers of female faculty. However, average salaries for women are still lower than those of their male counterparts at similar academic ranks or departmental positions. In the past, similar information could be rationalized because women were generally more junior than male colleagues, but the data indicate that senior women are also paid less than their male colleagues in equivalent positions. The encouraging news is that the percentage difference is declining; in some cases the difference is 5% or less. Determination of clinical productivity as patients seen per hour was not possible for this survey. Data were collected in a new format, and the calculations performed in previous years were not possible. The most relevant information would come from RVU data, but judging from the range of RVUs reported for this survey, programs appear to have very different ways of defining and reporting RVUs. For future surveys, additional information related to RVUs will be ascertained, for example, whether RVUs reflect the number of patients seen solely by the faculty physician or whether it also includes patients seen by residents supervised by the faculty physician. As seen in previous surveys, admission rates reported by participating programs are notably higher than the rates reported in the Centers for Disease Control and Prevention (CDC) s National Hospital Ambulatory Medical Care Survey. 7,8 Since 1998, SAEM surveys have reported average admission rates for res-

9 860 Watts et al. SAEM-AACEM SALARY AND BENEFITS SURVEY idency-associated hospitals of 21% to 22%. Over the same time period, the CDC estimates that ED admission rates have ranged from 12.8% to 15%. Tang et al. 9 report similar ranges between 1997 and In the present survey, only 22 of 94 hospitals (23%) had admission rates equal to or less than national averages; the majority had rates that were much higher. One explanation might be that many residency-associated hospitals are safety-net hospitals that treat greater numbers of acutely ill patients. LIMITATIONS The information from this survey is derived solely from the data provided by programs that chose to participate. Sixty-one percent (94 of 155) of RRC-accredited programs responded to the survey, so the demographic information presented may be reasonably representative. However, only 78 programs (50%) provided detailed compensation information, so generalizations from salary information should be made with that limitation in mind. CONCLUSIONS The Society for Academic Emergency Medicine salary survey indicates that most of the average salaries reported by the Association of American Medical Colleges for EPs are lower than those reported for faculty at Residency Review Committee approved EM residency programs. In addition, the Society for Academic Emergency Medicine survey illustrates that EP faculty continue to progress academically while working in very large and busy EDs treating numerous acutely ill patients. We thank the Office for Survey Research at the University of Michigan for their valuable assistance in the development and dissemination of the new electronic version of the salary survey. References 1. Kristal SL, Randall-Kristal KA, Thompson BM SAEM emergency medicine faculty salary and benefits survey. Acad Emerg Med. 2002; 9: Kristal SL, Randall-Kristal KA, Thompson BM. The Society for Academic Emergency Medicine s emergency medicine faculty salary and benefit survey. Acad Emerg Med. 2006; 13: Kristal SL, Randall-Kristal KA, Thompson BM, Marx JA SAEM emergency medicine faculty salary and benefits survey. Acad Emerg Med. 1999; 6: Kristal SL, Thompson BM, Marx JA SAEM emergency medicine faculty salary benefits survey. Acad Emerg Med. 1998; 5: Accreditation Council for Graduate Medical Education. Definitions of core faculty. Available at: lines.asp#time. Accessed Apr 12, Chen YC, Geraci W. Report on Medical School Faculty Salaries Washington, DC: Association of American Medical Colleges, McCaig LF, Nawar EW. National Hospital Ambulatory Medical Care Survey: 2004 emergency department summary. Adv Data. 2006; 372: Nawar EW, Niska RW, Xu J. National Hospital Ambulatory Medical Care Survey: 2005 emergency department summary. Adv Data. 2007; 386: Tang N, Stein J, Hsia RY, Maselli JH, Gonzales R. Trends and characteristics of US emergency department visits, JAMA. 2010; 304: Supporting Information The following supporting information is available in the online version of this paper: Data Supplement S1. Number of RRC-accredited programs contributing to SAEM salary surveys over last 20 years. Data Supplement S2. RRC-accredited programs reporting salary information to AAMC by region ( ). Data Supplement S3. Number and percentage of programs offering the following types of fringe benefits. Data Supplement S4. Percentage of programs reporting the following components considered for compensation. Data Supplement S5. Primary sources of departmental income ( ). Data Supplement S6. Sources of research funding reported and amounts. Data Supplement S7. Categories of departmental expenditures presented as percentage of annual income. Data Supplement S8. Characteristics of training hospitals and emergency departments (EDs) associated with participating programs. Data Supplement S9. Patient volume in low-acuity areas reported as percentage of total ED volume. Each bar represents a single ED (n = 65). Data Supplement S10. Patient length of stay stratified by number of annual ED visits for all patients, admitted patients, and discharged patients. Data Supplement S11. Number of programs that reported following types and hours of provider coverage broken down by annual ED volume ( ). Data Supplement S12. Number of faculty reporting the following combinations of clinical and non-clinical hours worked (those in shaded area were not included as full-time faculty). The documents are in Word document and PDF format. Please note: Wiley Periodicals Inc. is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing material) should be directed to the corresponding author for the article.