How does emergency medicine pay differ by employment model?

Self employed: the top figure, with the whole stack on you

The self employed average of $497,500 is the top of the spread, $69,000 above hospital employment, because no company stands between the physician and the revenue keeping a margin. It is also the figure with the most underneath it missing. The self employed physician carries malpractice personally, including the tail obligation when a claims made policy ends, buys disability and life coverage at individual prices, funds every dollar of retirement alone, and pays self employment tax at 15.3 percent, made up of 12.4 percent for Social Security up to the wage base and 2.9 percent for Medicare (Internal Revenue Service). There is no employer match, no paid leave, and no schedule guarantee beyond the contract in hand. None of that makes the model wrong. It makes the comparison honest only after the replacement stack is priced, which the W2 or 1099 topic does in dollars.

Medical groups: the surplus, shared

Medical groups average $461,000, $32,500 above hospital employment and $36,500 below the self employed figure. The structure explains the position. In a democratic group, the physicians hold the hospital contract themselves, bill for their own work, and share what remains after expenses as partner distributions, so the surplus a staffing company would keep flows to the physicians instead. Underneath the number sit the costs of running that structure: malpractice arranged by the group, with the tail terms set in the partnership documents, benefits the group buys for itself out of the same revenue, and the unpaid work of governance, scheduling, and contract renewal. The bank prices the group fork directly in democratic group partnership against staffing company pay.

Hospital employment and government: the package underneath

Hospital or health system employment averages $428,500, and the number underneath it is the fullest package in the specialty. The system carries malpractice, and the tail question is settled in the employment terms rather than left to the departing physician. Health premiums, group disability and life, paid leave, and a retirement plan with an employer contribution sit on top of the salary, invisibly. At public systems the retirement menu can hold both a 403(b) and a governmental 457(b), each with its own $24,500 elective deferral limit for 2026, while a nonprofit system can offer only the nongovernmental kind, and the employment itself can keep a Public Service Loan Forgiveness count alive, because eligibility follows the employer that pays you.

Government and military roles average $349,000, $79,500 below hospital employment and $148,500 below the self employed figure. What sits underneath is a different trade again: malpractice carried by the government employer, a benefits layer and retirement structure set by the public system rather than negotiated, loan forgiveness eligibility that follows government employment, and a schedule and mission bought deliberately at a lower rate. Physicians choose this model for the structure around the work as much as for the work itself.

Reading the spread correctly

Three cautions keep the spread useful. First, these are averages across different physicians, markets, and schedules, not four quotes for one job: the middle half of all self reported emergency pay runs from $360,000 to $500,000, so setting, region, and volume move a single offer further than the model label does. Second, experience moves the figures less than structure does in this specialty: Marit averages $402,500 at zero to two years of experience against $444,000 at eleven or more years, a $41,500 rise across a career, smaller than the $69,000 gap between hospital employment and self employment at a single moment. Third, the model decides questions the salary never mentions: who pays the tail when you leave, whether your loan payments count toward forgiveness, and whether a lost hospital contract ends your job or merely moves it. Compare models on the full sheet, the way the contracts questions on this site compare offers, and the spread becomes a tool rather than a ranking.