Emergency Medicine physicians (ER doctors) in the US earn an average of $317,480 per year, with significant variation based on location and staffing model.
Emergency medicine offers a unique work structure — shift work with no call from home, clear time off, and flexibility to pick up extra shifts or go part-time. But it comes with nights, weekends, holidays, high burnout, and career longevity concerns that make most ER doctors transition by their mid-50s.
Pay at a Glance (BLS Data)
Bureau of Labor Statistics wage estimates for emergency medicine physicians, across all industries:
| Percentile | Annual Wage | Hourly Equivalent |
|---|---|---|
| 10th (entry level) | $103,610 | $49.81 |
| 25th | $184,830 | $88.86 |
| 50th (median) | $335,550 | $161.32 |
| 75th | $418,890 | $201.39 |
| 90th | $495,910 | $238.42 |
| Average (mean) | $317,480 | $152.63 |
Source: US Bureau of Labor Statistics, Occupational Employment and Wage Statistics, May 2025, for Emergency Medicine Physicians (all industries). Hourly figures are annual wages divided by 2,080 hours. “Not published” means BLS withheld the estimate, usually because wages are above its top reporting limit.
What ER Doctors Actually Do
The reality of emergency medicine day-to-day:
| Shift Phase | Activities |
|---|---|
| Start of shift | Review board, get sign-out on existing patients, assess volume |
| Mid-shift | See new patients (4-6/hour), order tests, procedures, consults, reassessments |
| End of shift | Complete documentation, give sign-out, finish remaining dispositions |
Patient volume and acuity:
| Metric | Typical Community ER | Academic/Trauma Center |
|---|---|---|
| Patients per shift | 25-35 | 15-25 |
| Hours per shift | 10-12 | 10-12 |
| Patients per hour | 2-3 | 1.5-2.5 |
| Critical cases per shift | 1-3 | 3-8 |
| Admits to hospital | 20-30% | 30-50% |
Common procedures ER doctors perform:
| Procedure | Frequency | Complexity |
|---|---|---|
| Laceration repair | Daily | Low |
| Central lines | Weekly | Moderate |
| Intubation | Weekly | High |
| Chest tubes | Monthly | High |
| Fracture reduction | Weekly | Moderate |
| Lumbar puncture | Monthly | Moderate |
| Cardiac resuscitation | Weekly | High |
Quick Answer: ER Doctor Salary
| Metric | Amount |
|---|---|
| Average salary | $310,000-$350,000 |
| Hourly rate | $175-$350/hour |
| Entry-level salary | $275,000 |
| Experienced physician | $375,000+ |
| Medical director | $400,000+ |
| Locum tenens | $400,000-$500,000 |
ER Doctor Salary by State
| Rank | State | Avg Salary | Starting Salary | Median Salary |
|---|---|---|---|---|
| 1 | North Dakota | $424,750 | $208,740 | $392,890 |
| 2 | Rhode Island | $411,330 | $73,920 | $512,730 |
| 3 | Iowa | $401,640 | $168,250 | $429,050 |
| 4 | Missouri | $400,590 | $218,190 | $456,280 |
| 5 | Maryland | $387,020 | $220,020 | $451,620 |
| 6 | West Virginia | $381,470 | $62,830 | $491,230 |
| 7 | Vermont | $379,960 | $110,670 | $430,820 |
| 8 | Michigan | $377,660 | $117,780 | $417,760 |
| 9 | Minnesota | $375,630 | $125,750 | $390,940 |
| 10 | Massachusetts | $370,880 | $175,710 | $356,230 |
| 11 | Connecticut | $364,450 | $66,800 | $418,940 |
| 12 | Indiana | $360,570 | $220,790 | $347,060 |
| 13 | New Mexico | $360,410 | $158,680 | $405,130 |
| 14 | Nebraska | $353,880 | $71,290 | $371,880 |
| 15 | Washington | $348,790 | $105,220 | $380,870 |
| 16 | Ohio | $344,190 | $130,370 | $377,480 |
| 17 | Alaska | $341,520 | $120,420 | $452,620 |
| 18 | North Carolina | $340,980 | $179,080 | $339,350 |
| 19 | South Dakota | $335,490 | $210,850 | $393,870 |
| 20 | Florida | $301,220 | $182,950 | $204,990 |
| 21 | Oklahoma | $300,600 | $169,610 | $348,540 |
| 22 | Mississippi | $300,550 | $174,990 | $252,960 |
| 23 | District of Columbia | $292,750 | $235,610 | $318,200 |
| 24 | South Carolina | $285,730 | $116,020 | $341,960 |
| 25 | Texas | $262,170 | $71,930 | $316,830 |
| 26 | New Jersey | $262,080 | $73,880 | $315,340 |
| 27 | Georgia | $259,490 | $126,020 | $219,010 |
| 28 | New York | $257,790 | $80,210 | $301,690 |
| 29 | Idaho | $242,480 | $119,990 | $221,430 |
| 30 | Kentucky | $214,570 | $123,240 | $169,390 |
| 31 | Utah | $178,200 | $136,870 | $140,370 |
| — | National | $317,480 | $103,610 | $335,550 |
Source: US Bureau of Labor Statistics OEWS, 2025 estimates, fetched 2026-09-29. Figures cover Emergency Medicine Physicians (cross-industry). Some states are omitted where BLS did not publish a reliable estimate. Note: Rural and underserved areas typically pay significantly more.
ER Doctor Hourly Rates
| Shift Type | Typical Hourly Rate |
|---|---|
| Day shift (community ER) | $200-$275 |
| Night shift (community ER) | $225-$325 |
| Weekend shift | $225-$300 |
| Holiday shift | $275-$400 |
| Academic center | $150-$225 |
| Locum tenens | $250-$400 |
| Urgent care (MD) | $150-$225 |
ER Doctor Salary by Setting
| Setting | Annual Salary |
|---|---|
| Contract management group (CMG) | $300,000-$350,000 |
| Democratic group | $350,000-$400,000 |
| Hospital employed | $310,000-$360,000 |
| Academic medical center | $250,000-$325,000 |
| Rural/critical access | $350,000-$450,000 |
| Freestanding ER | $325,000-$400,000 |
| Pediatric ER | $280,000-$350,000 |
ER Doctor Salary by Experience
| Experience Level | Average Salary |
|---|---|
| New attending (1-2 years) | $275,000-$310,000 |
| Early career (3-5 years) | $310,000-$350,000 |
| Mid-career (6-10 years) | $340,000-$380,000 |
| Experienced (10+ years) | $350,000-$400,000 |
| Medical director | $375,000-$450,000 |
Path to Becoming an ER Doctor
| Stage | Duration | Typical Earnings |
|---|---|---|
| College (pre-med) | 4 years | -$100,000 (debt) |
| Medical school | 4 years | -$200,000 (debt) |
| Emergency medicine residency | 3-4 years | $60,000-$80,000/yr |
| Fellowship (optional) | 1-2 years | $75,000-$85,000/yr |
| Total training | 11-14 years |
Emergency Medicine Subspecialties
| Subspecialty | Salary Impact |
|---|---|
| Pediatric EM | Similar to general |
| Toxicology | $275,000-$325,000 |
| Sports medicine | $275,000-$375,000 |
| EMS/prehospital | $250,000-$350,000 |
| Ultrasound | Similar with PRN income |
| Critical care | $350,000-$450,000 |
ER Doctor Work Schedule
| Schedule Type | Hourly Impact |
|---|---|
| Full-time (typical) | Standard |
| Part-time | Higher hourly |
| Academic | Lower hourly |
| Night-only | +15-25% |
ER Doctor After-Tax Income
| Gross Salary | Federal Income Tax | Social Security + Medicare | Take-Home Before State Tax | Monthly |
|---|---|---|---|---|
| $275,000 | $59,384 | $16,102 | $199,514 | $16,626 |
| $325,000 | $76,884 | $17,276 | $230,839 | $19,237 |
| $375,000 | $94,384 | $18,452 | $262,164 | $21,847 |
| $425,000 | $111,884 | $19,626 | $293,489 | $24,457 |
2026 federal income tax for a single filer taking the standard deduction ($16,100), plus Social Security and Medicare. Not included: state and local income tax, retirement contributions and other pre-tax deductions. For your own situation, use the take-home pay calculator.
Locum Tenens ER Doctor Pay
| Factor | Locum Rate |
|---|---|
| Hourly rate | $250-$400 |
| Annual potential | $400,000-$600,000 |
| Housing provided | Yes |
| Malpractice covered | Yes |
| Travel expenses | Covered |
| Benefits | None (1099) |
Contract Management Groups (CMGs)
Most ER doctors work for staffing companies:
| CMG Type | Typical Pay |
|---|---|
| Large national CMG | $280,000-$340,000 |
| Regional CMG | $300,000-$375,000 |
| Democratic group | $350,000-$425,000 |
| Academic | $250,000-$325,000 |
ER Doctor Lifestyle
Emergency medicine offers unique lifestyle tradeoffs compared to other physician specialties:
The Real Advantages
| Advantage | Reality |
|---|---|
| No call from home | When your shift ends, you’re done. No 2am phone calls |
| Schedule flexibility | Easy to pick up shifts, go part-time, or take months off |
| High hourly rate | Among the highest hourly earnings in medicine |
| Variety of cases | Every shift is different — pediatric to geriatric, minor to critical |
| Procedural work | Hands-on medicine: lines, tubes, intubations, resuscitations |
| Team-based care | Work with nurses, techs, consultants — rarely alone |
| Shift mentality | Clear on/off times unlike primary care or surgery |
The Real Disadvantages
| Disadvantage | Reality |
|---|---|
| Night/weekend work required | Even senior physicians work nights. You never “graduate” past them |
| High burnout | 50-60% report burnout. Non-compliant patients, boarding, trauma take a toll |
| Holiday work | You’ll work Christmas, Thanksgiving, New Year’s throughout your career |
| Career longevity | Many ER docs can’t sustain night shifts past age 50-55 |
| Circadian disruption | Rotating day/night schedules damage health over time |
| Patient population | Drug seekers, psych holds, difficult social situations are common |
| Mid-level creep | NPs/PAs doing more ER work, potentially affecting long-term demand |
Who Should Consider Emergency Medicine
| You Should Consider EM If… | Why It Matters |
|---|---|
| You thrive under pressure | ER is controlled chaos. Stress tolerance is essential |
| You like variety | No two shifts are the same |
| You want schedule flexibility | Shift work enables part-time, locums, time off |
| You prefer procedures over relationships | You stabilize and refer, not long-term follow-up |
| You make decisions quickly | ER requires action with incomplete information |
| You can let go of outcomes | Not every patient can be saved. You need to process and move on |
Who Should NOT Become an ER Doctor
| Don’t Pursue EM If… | Why It Matters |
|---|---|
| You hate night shifts | Night work never ends in EM, unlike most other specialties |
| You want long-term patient relationships | You’ll never see most patients again |
| You struggle with uncertainty | EM frequently requires acting without complete information |
| You want highest physician income | Surgical subspecialties generally pay more |
| You want to work past 60 | Night shifts at 58 are brutal. Career longevity is poor |
| You need predictable daily routines | Shift work disrupts circadian rhythms significantly |
Building Wealth as an ER Doctor
Emergency medicine enables solid wealth accumulation — mid-tier physician salary, excellent hourly rate, and flexibility for extra shifts or side income.
Wealth trajectory:
| Stage | Typical Earnings | Net Worth Target | Key Moves |
|---|---|---|---|
| Residency completion | $60,000-$80,000 | -$250,000 | Student loans |
| Years 1-3 attending | $310,000-$340,000 | $0-$250,000 | Aggressive debt repayment |
| Years 4-7 attending | $340,000-$370,000 | $400,000-$750,000 | Max retirement, start taxable investing |
| Years 8-15 attending | $350,000-$400,000 | $1,000,000-$2,000,000 | Debt-free, heavy accumulation |
| Years 15-25 attending | $350,000-$450,000 | $2,500,000-$5,000,000 | FI achieved, tapering hours |
ER medicine wealth comparison (20-year trajectory):
| Specialty | 20-Year Earnings | Est. Net Worth at 50 |
|---|---|---|
| ER Medicine | $7,000,000 | $2,500,000-$3,500,000 |
| General Surgery | $8,500,000 | $3,000,000-$4,000,000 |
| Orthopedic Surgery | $12,000,000 | $4,500,000-$6,000,000 |
| Primary Care | $5,500,000 | $1,800,000-$2,500,000 |
| Dermatology | $8,500,000 | $3,500,000-$4,500,000 |
The wealth-building reality for ER docs:
- EM offers middle-tier physician wealth accumulation
- Flexibility enables side income: locums, urgent care shifts, telemedicine
- Part-time options preserve sanity while still earning $200k+
- Career transition risk (burnout, can’t sustain nights) is real financial consideration
- Earlier retirement planning essential — most can’t work ER past 55
ER Doctor Job Outlook
| Factor | Impact on ER Physicians |
|---|---|
| Emergency volume | ED visits continue growing with aging population |
| Physician shortage | EM residency slots increasing, but demand remains strong |
| Mid-level expansion | NPs/PAs handling more ER patients, especially lower acuity |
| Telemedicine | Limited impact — ER requires physical presence |
| Freestanding ERs | Growing market, some with higher pay |
| Burnout/turnover | High, creating continuous openings |
Demand outlook:
| Factor | Status |
|---|---|
| Job growth (2025-2035, physicians and surgeons overall) | 4% |
| Current job availability | Strong |
| Residency competitiveness | Moderate (no longer ultra-competitive) |
| Locum tenens demand | Very strong |
| Rural/underserved need | Critical shortage |
Bottom Line
ER doctors earn $275,000-$375,000 annually, with locum tenens positions paying $400,000-$600,000. High hourly rates make emergency medicine one of the best-paying physician specialties per hour worked.
Here’s what actually matters:
-
EM offers the best schedule flexibility in medicine. No call from home, easy to go part-time, simple to pick up extra shifts. This is worth real money in quality of life.
-
Night shifts never end. Even senior physicians work nights and weekends. Unlike surgery or cardiology, you don’t “graduate” to daytime-only schedules. This burns people out.
-
Career longevity is 20-25 years typically. Most ER doctors can’t sustain night shifts past 50-55. Plan for transition (urgent care, administration, teaching) or early retirement.
-
Mid-tier physician income, but excellent hourly rate. Its median is below many surgical specialties, but ER doctors work fewer hours. Per-hour compensation is competitive.
-
Locum tenens is the income maximizer. Working locums can push earnings to $500k+. Many ER docs do locums part of the year for geographic flexibility and higher pay.
-
Burnout is the specialty’s defining challenge. 50-60% of ER physicians report burnout. Difficult patients, boarding, night shifts, and moral injury take a toll. Mental health maintenance is essential.
-
EM is a good specialty if you want flexibility, procedural work, and variety — but not if you want highest income, daytime hours, or a 35-year career. Know what you’re choosing.
ER Doctor Take-Home Pay After Taxes
A $330,000 gross emergency medicine salary looks very different after federal and state taxes, malpractice insurance, and loan repayments. Here’s a realistic breakdown for a mid-career ER physician:
| Item | Annual | Monthly |
|---|---|---|
| Gross salary | $330,000 | $27,500 |
| Federal income tax (~35% effective) | -$115,500 | -$9,625 |
| State income tax (avg 5%) | -$16,500 | -$1,375 |
| FICA (Medicare 2.9% — no SS cap) | -$9,570 | -$798 |
| Malpractice insurance | -$12,000 | -$1,000 |
| 401(k) / 403(b) max contribution | -$23,500 | -$1,958 |
| Student loan payment (typical) | -$36,000 | -$3,000 |
| Estimated take-home | ~$117,000 | ~$9,750 |
After a decade of medical training and often heavy student debt, an ER doctor at the BLS median ($335,550) keeps about $19,800 a month after 2026 federal income tax and FICA, before state tax and loan payments: comfortable by any measure, but well below what the headline figure suggests. Attending salary truly kicks in once loans are paid off, typically 8–12 years post-residency.
Related Salary Guides
See every profession in our salary by profession guides.
Sources
- U.S. Bureau of Labor Statistics. “Occupational Employment and Wage Statistics, May 2024.” bls.gov/oes
The content on Wealthvieu is for informational purposes only and should not be considered financial, tax, or investment advice. Consult a qualified professional before making financial decisions. Full disclaimer · Editorial policy