The other big factor that will determine pay in emergency medicine aside from the aforementioned geography, supply/demand, volume, acuity, payer mix, etc. is the type of practice the hospital employs.
I'm going to rate these in order of desirability from lowest to highest, and realize that it's just my opinion (though I think widely shared).
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Lowest: Paid employee of for-profit hospital or HMO.
Both of these entities have one primary goal in mind--making money. Taking care of patients and keeping their employees happy is clearly of secondary importance or less. Their primary obligation is to their stockholders, and the stockholders want a return on their investment. The obvious corollary is that they'll pay their employees (including you) as little as they can get away with. The only good thing is that as an employee, you'll probably get a reasonably full benefit package.
They may offer a performance incentive, but don't expect to get rich off it.
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Middle: Paid employee of non-profit hospital, medical megacorporation, or working for another physician or group of physicians who owns the contract for the hospital.
While there are still interests at the top of the organization that want a piece of your earnings, the motivation in these types of practices is at least less profit-oriented. Not-for-profit hospitals usually have patient care as the primary goal of their institution and employee happiness and an important secondary goal. That said, if the not-for-profit hospital is having trouble making ends meet, they'll have to start cutting costs, and your salary is a cost. You do the math.
Working for a megacorp (EmCare, TeamHealth, etc) that specializes in providing physician services falls in here as well. Again, they have higher ups that profit from your work and have an interest in getting the maximum productivity out of you. They also have a vested interest in keeping you happy, so they'll pay you better than the HMOs and work harder to provide the services and benefits you want.
Working for a small physician contract-holder falls in this range as well for the same reasons, and can be better or worse than either of the above depending on the benevolence of the contract holder(s). The same caveats apply as with the megacorps in that somebody higher up in the food chain is benefiting significantly from the work that you do and depriving you of the money you earned. Many question the ethics of physicians who do this to other physicians, and rightly so I think.
Benefits in this category vary considerably, though many such jobs are only as independent contractors. That means that they often provide little or no benefits, and you have to fend for yourself as far as disability, retirement, health and dental, and perhaps even malpractice.
You are more likely to receive a performance incentive in these practice environments, but again don't expect to retire in 10 years from it.
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Highest: Partnership in a democratic group
This is the holy grail of emergency medicine practice (aside from being a lowlife moneygrubbing contract-holder squeezing other physicians dry, depending on how ethical you are). In this practice, you own a part of the practice as do all your colleagues, and all decisions of the practice are decided by vote. The pay is distributed equitably, and any extra earnings are distributed to the working physicians with only the costs of administration and overhead subtracted. As far as stability, compensation, and job satisfaction, this situation is almost always the best.
The physicians in democratic groups are generally more involved in the medical community and hospital committees than in the previous situations, which increases their bargaining power when it comes time to negotiate the contract. You'll have more say in how the emergency department is run, and to a certain extent, how other services (especially ancillary services) in the hospital run.
The pay is clearly better than any of the other described work situations for obvious reasons.
For these reasons, they can generally afford to hire the best physicians available, so your colleagues will be of generally higher calibur than you would find in the previous categories.
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I think it's obvious which work environment I prefer, though some prefer the first type of arrangement. Working as a salary-man is fine for those that just want to clock in, clock out, and collect a paycheck, as long as they're content with collecting a smaller paycheck than their colleagues in democratic groups. I have friends who prefer this lifestyle, and that's fine for them. Whether it suits you is something you have to decide for yourself.
