Emergency Medicine & Hospital-Based Physician Salaries 2025

Hospital-based medicine operates on fundamentally different economics than traditional office-based practice. There's no slowly building patient panel, no establishing referral networks over years, no concerns about whether patients will show up for appointments. Instead, you clock in for your shift, handle whatever comes through the door, and clock out when it's done.

If you're drawn to emergency medicine, hospital medicine, or urgent care, understanding compensation in these specialties means thinking in shifts and hours, not just annual salaries. The numbers look different, the lifestyle trade-offs are unique, and the path to maximizing your income follows entirely different rules.

How Much Does an Emergency Room Doctor Make a Year?

Emergency medicine physicians earn a median annual salary of $373,000 nationally. Break that down and you're looking at $31,083 monthly or roughly $179 per hour based on a standard full-time calculation. But here's where emergency medicine gets interesting: most ER doctors don't work anything resembling a traditional full-time schedule.

The typical emergency physician works 12-15 shifts per month. Each shift runs 8-12 hours depending on the facility and staffing model. Do the math and many emergency physicians work somewhere between 120-180 hours monthly—significantly less than the 160+ hours that defines full-time in most specialties.

This creates a fundamentally different compensation model. You're earning excellent hourly rates but working fewer total hours. Many emergency physicians maintain strong six-figure incomes while working what would be considered part-time in other fields. Others work additional shifts beyond their base commitment, picking up per diem work that can push annual income well above the median.

The Shift Economics of Emergency Medicine

Understanding ER compensation requires thinking in shifts, not salaries. A typical full-time emergency physician commitment might be:

• 14 shifts per month
• 10 hours per shift
• 140 hours monthly
• 1,680 hours annually

At $225 per hour (a reasonable mid-range rate), that's $378,000 annually for what many would consider less than full-time work. Pick up two extra shifts monthly and you've added $54,000 to your annual income.

This is why many emergency physicians structure their careers around flexibility. Work 12 shifts monthly and earn $320,000 while maintaining time for family, hobbies, or side ventures. Or work 18 shifts monthly and push toward $480,000. The choice is yours in ways that office-based practice rarely permits.

Per Diem and Premium Rates

Emergency medicine's shift-based model creates a robust market for per diem work—temporary coverage that hospitals need filled. These shifts command premium rates because hospitals need coverage now and physicians have leverage.

Standard per diem rates run:

• Weekday shifts: $225-$300 per hour
• Weekend shifts: $250-$325 per hour
• Holiday shifts: $300-$400 per hour
• Overnight shifts: Add 10-20% to base rates

Work a 10-hour Saturday shift at $275 per hour and you've earned $2,750. Doing this four times a month adds $11,000 to your monthly take-home, totaling $132,000 in additional gross annual income. This arithmetic attracts physicians who want to maximize earnings or those who value flexibility over stability.

Some emergency physicians build entire careers around per diem work, maintaining relationships with multiple facilities and working when and where they choose. You lose benefits and employment stability, but gain schedule control and often higher effective hourly rates than employed positions offer.

How Much Does an ER Doctor Make in New York?

Emergency physicians in New York State earn approximately 8-12% above the national median, though this varies dramatically between New York City and upstate regions.

New York City and Surrounding Metro

In NYC and surrounding areas, emergency physicians typically earn $395,000-$430,000 annually. The hourly breakdown usually runs $210-$250, with most physicians working 13-15 shifts monthly.

The higher compensation reflects cost of living, certainly, but also the unique challenges of New York emergency medicine. NYC emergency departments see extraordinary volumes—major trauma centers might see 80,000+ visits annually. You're managing significant psychiatric presentations, complex social situations, language barriers across dozens of languages, and high percentages of uninsured patients creating documentation complexity.

Manhattan emergency physicians face additional pressures: tiny physical spaces in older hospitals, patient populations with extremely high expectations, and the intensity that comes with some of the nation's highest-acuity cases. The compensation premium reflects these realities.

Upstate New York Markets

Buffalo, Rochester, Syracuse, and Albany offer $380,000-$410,000 for emergency physicians, with hourly rates of $205-$240. You're typically working 14-16 shifts monthly, slightly more than NYC positions.

Here's what makes upstate New York interesting: you're earning nearly comparable compensation to NYC but with dramatically lower costs of living. A $390,000 salary in Buffalo provides significantly more purchasing power than $420,000 in Manhattan. Housing costs alone create a $30,000-$50,000 annual difference in effective income.

Upstate emergency departments tend to be more manageable environments—lower volumes, less acute presentations on average, and patient populations more similar to typical American emergency medicine. The lifestyle often proves more sustainable than high-intensity urban emergency medicine.

Rural New York Premium

Rural emergency departments struggle to recruit physicians, creating compensation premiums. These positions often pay $400,000-$450,000 with additional sweeteners:

• Signing bonuses: $25,000-$50,000
• Student loan repayment assistance
• Relocation packages
• Housing stipends
• Guaranteed schedules with minimal weekend/holiday requirements

A rural emergency physician might work 15 shifts monthly at $260 per hour in a 30,000-visit-per-year department. The pace is manageable, the complexity lower on average, and the schedule predictable. You're trading urban amenities for financial advantages and lifestyle sustainability.

Who Signs Your Paycheck: Employment Models Matter

Emergency medicine compensation depends heavily on who employs you, and this landscape has shifted dramatically over the past decade.

Contract Management Groups

Companies like Envision Healthcare, TeamHealth, and US Acute Care Solutions manage emergency departments for hospitals nationwide. They employ the majority of emergency physicians and set compensation structures.

Working for a CMG typically means:

• Guaranteed base salary plus production bonuses tied to patient volumes or RVUs
• Comprehensive benefits including malpractice insurance
• Flexibility to move between facilities within the same company network
• Less local control over scheduling and practice patterns

CMG compensation generally runs at or slightly below market medians. A typical CMG position might offer $360,000 base salary with bonus potential to $385,000-$395,000. The benefits package adds value, but you're trading income ceiling for stability and flexibility.

The corporate consolidation of emergency medicine has proven controversial. Many physicians report decreased autonomy, increased productivity pressure, and less favorable schedules as these companies optimize for profit. But others appreciate the structure, benefits, and ability to relocate within the same employment network.

Democratic Groups

Physician-owned democratic groups represent traditional emergency medicine. These are partnerships where physicians share ownership, governance, and profits from hospital contracts.

Democratic groups typically offer:

• Competitive base salaries
• Partnership tracks where you buy into ownership and share profits (adding $50,000-$100,000+ annually)
• Significant voice in group governance and practice patterns
• Stability and alignment between physician interests and group interests

Getting hired into a democratic group usually requires proving yourself. Groups are essentially choosing future partners, so cultural fit and clinical competence both matter. But once you're in and make partner, you're part-owner of a business that can be quite lucrative.

Hospital Employment

Some hospitals, particularly academic medical centers and large integrated systems, directly employ their emergency physicians rather than contracting with outside groups.

Hospital employment offers:

• Stable salaries without production pressure
• Comprehensive benefits
• Clear expectations and defined schedules
• Academic opportunities in teaching hospitals
• Less income upside but more predictability

Academic emergency medicine typically pays $340,000-$380,000, below private practice but with teaching opportunities, research time, and the prestige of university affiliation. For physicians who value these elements, the compensation trade-off makes sense.

Locum Tenens: The Ultimate Flexibility

Locum tenens, temporary physician coverage, thrives in emergency medicine because the shift-based model makes temporary staffing straightforward. Hospitals need shifts covered; locum physicians fill them.

Locum emergency medicine pays:

• $250-$350 per hour depending on location and urgency
• Travel, housing, and meal stipends
• Complete schedule control
• But: no benefits, no job security, constant travel

Some emergency physicians build careers around locum work, choosing when and where to work while earning $350,000-$450,000 annually on their own terms. You're trading stability for flexibility and often earning premium rates that employed positions can't match.

Hospital Medicine: The Hospitalist Revolution

Hospitalists didn't exist as a specialty 30 years ago. Now they represent one of medicine's fastest-growing fields, created to meet hospitals' needs for physicians dedicated to inpatient care.

What Hospitalists Actually Earn

Hospitalists earn a median of $316,000 annually. Like emergency medicine, this typically involves shift work, though structured differently. Most hospitalists work 7-on/7-off schedules, seven consecutive day or night shifts followed by seven days off, or variations like 14-on/14-off or other block schedules.

Breaking down hospitalist compensation:

• Base salary: $280,000-$300,000
• Production bonuses: $15,000-$40,000 (based on RVUs, patient encounters, or shift coverage)
• Night shift differential: Additional $25,000-$40,000 for nocturnist positions
• Weekend requirements: Usually built into the schedule

Nocturnists—hospitalists working permanent night shifts, earn premium compensation, typically $320,000-$360,000. The differential reflects both the difficulty of overnight work and the lifestyle impact of permanent night schedules. Your circadian rhythm never fully adjusts, social life suffers, and the health impacts of chronic night work are real. The extra compensation matters.

The Schedule Trade-Off

Hospital medicine's 7-on/7-off model creates unique lifestyle dynamics. During your on-week, you're working hard, typically 10-12 hour shifts managing 15-20 patients daily, with significant documentation burden and constant decision-making.

But your off-week is truly off. You're not fielding patient calls, not worrying about clinic schedules, not on call. Many hospitalists describe this as the specialty's greatest advantage: true separation between work and life.

The downside? Seven consecutive working days is grueling. By day six or seven, you're exhausted. Family time during work weeks essentially disappears. If you have young children, you might see them for an hour in the morning before they're off to school and you're off to the hospital.

Whether this trade-off works depends on your priorities and life situation. Some physicians thrive on the clear boundaries. Others find the intensity of work weeks unsustainable.

Regional Hospitalist Market

Geographic variation in hospitalist salaries is less dramatic than in many specialties because demand is relatively consistent across markets. Sick patients need hospitalization everywhere.

Still, differences exist:

• Major urban centers: $310,000-$340,000
• Suburban markets: $305,000-$330,000
• Rural hospitals: $330,000-$370,000

Rural premiums reflect recruitment challenges. A 100-bed community hospital in rural Montana needs hospitalist coverage just like a major academic center, but recruiting physicians to small towns requires financial incentives. These positions often include signing bonuses ($30,000-$50,000), student loan repayment, and relocation packages.

What is the Average Salary for an In-House MD/Physician for Urgent Care System?

Urgent care represents a hybrid between emergency medicine and primary care—handling acute but non-life-threatening conditions on a walk-in basis with extended hours but without the intensity of true emergencies.

Urgent Care Compensation Reality

Urgent care physicians earn considerably less than their emergency medicine colleagues, with typical compensation of $240,000-$280,000 annually. This breaks down to roughly $115-$135 per hour for full-time work.

The lower compensation compared to emergency medicine reflects several factors:

• Lower patient acuity (sprained ankles, strep throat, minor lacerations versus heart attacks and trauma)
• More predictable workflows without the chaos of true emergencies
• Better work-life balance with defined hours
• Less liability exposure
• Lower stress and intensity

For many physicians, this trade-off makes sense. You're earning solid income while maintaining reasonable hours and manageable stress levels.

Full-Time Urgent Care Positions

Typical full-time urgent care employment includes:

• Annual salary: $240,000-$280,000
• Schedule: 36-40 hours weekly with rotating weekend coverage
• Benefits: Standard employed physician package including malpractice insurance, health insurance, retirement contributions, and PTO
• Patient volume: 15-25 patients per shift depending on facility

Many urgent care systems are owned by corporations (CityMD, GoHealth, Carbon Health) or hospital networks running their own urgent care centers. These entities offer employed positions with standard benefits but limited autonomy.

Per Diem Urgent Care

Per diem urgent care positions pay hourly without benefits:

• Hourly rate: $130-$160
• Weekend/evening premium: Add 10-15%
• Complete schedule flexibility
• No benefits, no guaranteed hours

Some physicians cobble together careers from per diem urgent care work, working at multiple facilities and controlling their own schedules. Others use per diem urgent care to supplement income from other positions—maybe you're a primary care physician working three clinic days weekly and picking up one urgent care shift for extra income.

Medical Director Roles

Urgent care medical directors oversee clinical operations across multiple locations:

• Salary: $260,000-$300,000
• Reduced clinical time (maybe 50-70% clinical, 30-50% administrative)
• Responsibilities include quality oversight, policy development, and provider supervision
• Career growth path for those interested in healthcare leadership

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Making Your Hospital-Based Career Decision

If you're considering hospital-based medicine, think beyond salary figures to the lifestyle realities and psychological demands.

Emergency medicine works for physicians who:

• Thrive in high-acuity, unpredictable environments
• Value schedule flexibility and defined work hours
• Want no long-term patient management responsibilities
• Handle rapid decision-making and multi-tasking well
• Can process difficult cases emotionally and move forward

Hospital medicine suits physicians who:

• Enjoy inpatient medicine's complexity
• Appreciate block scheduling with extended time off
• Prefer defined work hours without call interrupting life
• Work well in team-based care models
• Can manage high patient volumes efficiently

Urgent care attracts physicians who:

• Prioritize work-life balance over maximizing income
• Prefer moderate acuity without life-or-death stakes
• Value shorter patient encounters
• Want defined schedules without call
• Accept lower compensation for reduced stress

The key is honest self-assessment. High emergency medicine compensation doesn't matter if you're miserable and burned out. Lower urgent care income might be perfect if the lifestyle supports your overall life goals and keeps you professionally satisfied.

Hospital-based medicine offers genuine advantages: excellent hourly compensation, schedule flexibility, no long-term patient management, and immediate impact on acute illness. These specialties won't suit everyone, but for physicians who match the work style, they provide rewarding careers with strong financial returns and the ability to maintain boundaries between work and personal life that office-based practice often can't match.

Sources

Salary data and compensation information sourced from:

• Medscape Physician Compensation Report 2024
• American College of Emergency Physicians (ACEP)
• Society of Hospital Medicine (SHM)
• Bureau of Labor Statistics (BLS)
• Medical Group Management Association (MGMA)