Emergency Physician Supply and Demand: Migration Trends

Historically, when asked which states most providers consider outside of training, or in general, the standard answer was that they either were born/have family in a particular state, trained in a particular state, or were considering one of the “big five”. The “big five” consists of California, Florida, New York, Texas, and Washington. It is no coincidence that these are among the five most populous states with some of the biggest economies in the country.

Today however, the ever changing landscape within healthcare is reshaping the marketplace like never before.  Emergency medicine is reacting to two main contributors to physician migration trends, including the national climate over the last several years and the introduction of  freestanding emergency departments that are rapidly expanding in a few key states.

Freestanding Emergency Departments

While freestanding emergency departments, or emergency care centers, are not a new topic, there is a difference in how they are now presented and operated.  In the past, freestandings were often affiliated with a hospital system.  However, in the last three years, Texas (primarily), Colorado, Rhode Island, and Delaware have incorporated state approved, independent freestanding emergency departments. In total, as per ACEP 2015, their panel believes that there are now over 500 centers nationally. 

Texas has been the most progressive state in allowing privately-owned freestandings to be developed.  As a result, this has created a giant wave of FSED’s into the marketplace creating an oversupply of jobs for the first time in a long time.  We have seen compensation benchmarks in major markets sky rocket as a result, and in turn, we have seen many physicians relocating to Texas. The other states listed in the freestanding market are also seeing a larger concentration of providers give consideration as more jobs develop. 

It is worth noting that Colorado, Rhode Island, and Delaware are closer to the beginning stages of the cycle, and that Texas is considered to be closer to maturity.  It is also worth noting that Arizona, California, and Georgia are getting very close to allowing the development of freestanding emergency departments. 

(We recently published this article on freestanding vs. urgent care volume trends.)

National Climate

We are all aware of what Winter Storm Jonas recently provided to the east coast, and for those reading in the northeast, you are all more than familiar with the last five or six years of some of the harshest winters on record.  This alone has spurred a tremendous interest in moving to warmer locations, or locations with what some would deem “milder winters”. 

We find that our west coast groups, including Hawaii, have received roughly 60% or more of their rosters from the greater northeast as a result.  The remaining balance comes from the local marketplace and the remainder of the country.  This is significant given that most of our groups along the west coast (excluding Hawaii) have historically relied on more of a local candidate pool.   

Atlas Van Lines also recently released their “2015 Migration Patterns” data which shows the greater Midwest and the Northeast as the two strongest areas with outward migration patterns.  Their data suggest that in order to be considered an “outbound” state that more than 55% of total shipments are moving away from the state.  The data also reflects three out of the “big five” states (Florida, Texas, Washington) being considered “inbound” and California being balanced. 

Additional Factors

A large concentration and percentage of our country’s population resides between Chicago and New York with a higher percentage of emergency medicine training programs also located in this region.  One would quickly infer that most providers choose to live in this region based on the aforementioned.  While this is mostly true, basic economics will tell you that an oversupply of providers in a market will provide less in compensation, while areas with an imbalance of jobs to providers will offer more in compensation. For this reason, we tend to see more physicians relocating from this region upon entering the workforce.