555 EM spots did not fill in Match

[Franzd'Epinay]

Guess who you guys call to admit these people? me, the hospitalist. Lol

Ok, but hear me out, what if it's not a safe discharge?

---

Members don't see this ad.

 

[Franzd'Epinay]

In her defense, you are coming off rather condescending in your posts. Not really professional. Medicine has the bad rap where "senior residents and attendings eat their young" with all the negativity and such. This ain't helping. I say that with all due respect, but these are the kinds of post that give SDN a bad rap.

How exactly do you think you came off?

You have several attendings listing many concrete downsides to the practice of EM in 2023 and you roll in with "I know I'm an M1, but have you considered that all specialties have their negatives? Bet you didn't think of that, huh. Also, what if WWIII breaks out next week? Anything can happen™"

I get that you're trying to be supportive, but this ain't it chief.

 

[DoctorMD1]

I appreciate your lengthy advice. I mentioned this earlier but I think it got drowned out by people calling me “honey” in a condescending fashion…

I didn’t literally mention peds and geriatrics. I just meant you see it all from babies to people near the end of their life. I like that the ED population is wide and not super subspecialized. But the point Mount A. made was well taken 🤣

The point you made about no long term continuity with patients is also something that’s interested me about the speciality. Perhaps I’d do better opening an urgent care one day. Who knows 🤷🏼‍♀️ time will tell as I go through rotations. I certainly am not dead set on the speciality, it’s just the one I’ve had the most interest in and exposure to over the years.

I think you’ve pointed out a lot of good information for me to review and I really appreciate it! I’ve been trying to find an IR to shadow as I think that would definitely be a speciality of interest. I’ll add anesthesia to the list too! Checks a lot of boxes.

IR is very competitive to match directly. However, it is very non competitive fellowship after DR residency.

 

[Birdstrike]

My very first post on SDN 13-years ago was, "That's it, I'm done. I'm leaving EM." I took a lot of heat for my comments over the years. But it looks like I made the right move.

 

[Splenda88]

Yeah but hospitalists and consultants forget about the other >10 patients of the same complete nonsense we fight family with to get discharged home.

I have a lot of respect for you guys. I have NEVER argued with you guys or refused any of your admissions. I think you guys have one of the most difficult jobs in medicine. I spend time watching a 2-hr soccer game at work while you guys cant sit for even a 15 minutes enjoying a meal.

 

[Franzd'Epinay]

My very first post on SDN 13-years ago was, "That's it, I'm done. I'm leaving EM." I took a lot of heat for my comments over the years. But it looks like I made the right move.

That's surprising. I think the only negative reactions to your (career-related) posts that I have seen have come from anesthesiologits raging at your support of EM as a base to pain.

 

[Prehealth1011]

I think you’ve pointed out a lot of good information for me to review and I really appreciate it! I’ve been trying to find an IR to shadow as I think that would definitely be a speciality of interest. I’ll add anesthesia to the list too! Checks a lot of boxes.

I'm in IM. I second the Anesthesia idea. Even if you end up not enjoying it, better realistic fellowship options (pain) and they have an outpatient outlet with ambulatory surgical center jobs. Spoke to an anesthesia senior resident who signed up for one of these jobs. She'll make decent money and doesn't even have to intubate people.

 

[BillBill1219]

Thanks for all the solid advice here! IM is definitely a great specialty and will likely be at the top of my list of considerations because of the wide variety of fellowship opportunities as well as opportunities straight out of residency. I think because I'm a non-trad student and older than most of my peers it's probably harder for me to not stress about these things too early... It's way too easy to feel like I am already behind the curve a bit. But I'll definitely heed your advice and just focus on academic success for now.

I undersand. I too am on the older side and was a non-traditional student. I have often felt that I am behind as you have suggested (and have been the recipient of many unwarranted, condescending remarks on SDN. I was even referred to ichthyosis patients to learn about thicker skin.) That aside, there is nothing anyone can do to alter the timeline of this extremely long, arduous path. Worrying excessively about things like this will likely just be a distraction.

 

[rokshana]

In her defense, you are coming off rather condescending in your posts. Not really professional. Medicine has the bad rap where "senior residents and attendings eat their young" with all the negativity and such. This ain't helping. I say that with all due respect, but these are the kinds of post that give SDN a bad rap.

She is gonna tell me to “listen”… she gets a bless your heart…being disrespectful gets you the same.
But apparently M0 already know everything…🙄🤦🏽‍♀️

 

[MDbecomesMD]

IR is very competitive to match directly. However, it is very non competitive fellowship after DR residency.

Good to know!

 

[MDbecomesMD]

I undersand. I too am on the older side and was a non-traditional student. I have often felt that I am behind as you have suggested (and have been the recipient of many unwarranted, condescending remarks on SDN. I was even referred to ichthyosis patients to learn about thicker skin.) That aside, there is nothing anyone can do to alter the timeline of this extremely long, arduous path. Worrying excessively about things like this will likely just be a distraction.

Thank you so much for your empathy and advice. I really appreciate your perspective and will heed your advice— one day at a time!

 

[MDbecomesMD]

She is gonna tell me to “listen”… she gets a bless your heart…being disrespectful gets you the same.
But apparently M0 already know everything…🙄🤦🏽‍♀️

I genuinely didn’t mean “listen” in any disrespectful fashion. Perhaps it’s a regional thing, but that’s just how I talk. I’m sorry if I offended you. Unfortunately tone of voice doesn’t translate well over the internet.

 

[rokshana]

I genuinely didn’t mean “listen” in any disrespectful fashion. Perhaps it’s a regional thing, but that’s just how I talk. I’m sorry if I offended you. Unfortunately tone of voice doesn’t translate well over the internet.

Thank you

 

[MDbecomesMD]

Thank you

Of course. I know I’m a newbie but I’m not a jerk. I appreciate all the advice given to me here. You guys can continue your prior conversations.

 

[Mount Asclepius]

MDbecomesMD is naive, but we all were as M0s. I do feel that they have been respectful and gracious. I think a lot of us are so passionately negative as we wish we could go back and tell our former selves so much of what we know now that isn't truly well presented to medical students.

 

[Oligodinero]

If just 2 of these programs could be shut down, emergency medicine in California might have a fighting chance. Ideally, an Inland Empire based program (RUHS, Desert, or Arrowhead) and Kaweah Delta should bite the bullet and close shop.

• Kaweah Delta Health Care District-CA (wow.... really misgauged their competitiveness)

What's even more shocking is that Kaiser Modesto filled all their spots, being 2 years old and having to ship their trauma and peds rotations to other hospitals. I think it's probably got to do with the high salary they're paying their residents....which last I checked was possibly the highest paid EM residency in the country. Kaweah Delta is certainly more established and has a much larger catchment than KP Modesto does.

 

[Mount Asclepius]

I would rather never see another peds patient (or really, another geriatric patient - which is especially applicable because I live in the United States Capital of Old People).

I didn’t literally mean peds and geriatrics specifically. I meant it more as a range from peds patients all the way to geriatrics.

I didn’t literally mention peds and geriatrics. I just meant you see it all from babies to people near the end of their life. I like that the ED population is wide and not super subspecialized. But the point Mount A. made was well taken

I know RustedFox's post was in response to something you said MDbecomesMD, but my post of comedy was primarily replying to RustedFox.

I did understand what you meant regarding taking care of the full spectrum of life.

I too bought into liking EM for the breadth. Now I don't like pediatric or geriatric patients. I also don't really like psychiatric, OB, trauma or ortho patients (sorta still like a good straight forward reduction). Yep, I've thought about that a lot (and it grows) ever since residency knowing where that leaves me, but just hasn't felt worth the effort to jump to the speciality I do like when I have serious doubts about all of medicine.

 

[hebel]

That's surprising. I think the only negative reactions to your (career-related) posts that I have seen have come from anesthesiologits raging at your support of EM as a base to pain.

Not sure how long you've been on SDN (your profile says 2019), but @Birdstrike was saying this stuff back when EM was a HOT specialty.

I graduated medical school in 2016 and was frequently on this forum because I was planning on doing EM at the time. Fortunately(!) I ended up not liking my 4th year EM rotations and made a last minute switch to psychiatry. EM was so popular and the job market was so good at the time that it was a surprisingly hard choice to make, but I remember birdstrike being one of a few forum members at the time who was going against the grain and whose posts gave me the confidence to go with my gut.

 

[Franzd'Epinay]

Not sure how long you've been on SDN (your profile says 2019), but @Birdstrike was saying this stuff back when EM was a HOT specialty.

I graduated medical school in 2016 and was frequently on this forum because I was planning on doing EM at the time. Fortunately(!) I ended up not liking my 4th year EM rotations and made a last minute switch to psychiatry. EM was so popular and the job market was so good at the time that it was a surprisingly hard choice to make, but I remember birdstrike being one of a few forum members at the time who was going against the grain and whose posts gave me the confidence to go with my gut.

Yeah, I’ve been reading @Birdstrike posts for well over a decade. Back then I think it was mostly patient vignettes (the one with the little girl's shoes was particularly memorable) along with the occasional post on quitting.

I think the consensus back then was “you’re not wrong, but I can’t give up all this money to join you”. I don’t think anyone (bird included) was predicting the explosion of residencies a decade+ ago. Or, who knows, maybe I’m rewriting history in my head.

 

[nynydoc]

Nearly 10 years ago I tried to switch into EM and cold called some of the programs on that list. Some of the PDs ignored my emails and those same programs filled 0 spots. I wonder if they’d share the same sentiment today to give a professional courtesy email back.

Never been happier to not be in EM. Life’s too short to not have control of your nights and weekends.

 

[cyanide12345678]

Not sure how long you've been on SDN (your profile says 2019), but @Birdstrike was saying this stuff back when EM was a HOT specialty.

I graduated medical school in 2016 and was frequently on this forum because I was planning on doing EM at the time. Fortunately(!) I ended up not liking my 4th year EM rotations and made a last minute switch to psychiatry. EM was so popular and the job market was so good at the time that it was a surprisingly hard choice to make, but I remember birdstrike being one of a few forum members at the time who was going against the grain and whose posts gave me the confidence to go with my gut.

2016 med school grad as well. EM was soooo hot. Literally we were told that anything less than a 230-240 step 1 and you were done, pick another specialty.

Some of the most accomplished and well rounded people in my class went into EM, the sort of people who truly could have gone to any specialty.

I wish i had read birdstrike posts when applying. I hadn’t. I wish i wasn’t disillusioned into thinking that working nights won’t affect me since i love staying awake at nights. I wish i didn’t think like an idealist - thinking i want to take care of everyone, the alcoholics, the psych patients etc. Unfortunately there is a large size of the population that is disrespectful, belligerent, and just not good people.

You know…. It gets old being told to F off multiple times when you’re trying to talk to a patient. Just today had a girl high on meth, acutely psychotic, telling me to F off like a dozen times. Another psych guy who threatened to shoot himself wanted to walk out and was telling me to F myself and was threatening to sue. It gets old taking care of someone like that and thinking of what’s best for them when all they do is be demeaning towards you. Do i want them as patients??? Hell no. So much B52 given today -_-

Those kind of patients wouldn’t be near a specialist - heck no. Most of them have an insurance and co pay barrier to entry -_-

 

[miacomet]

Nearly 10 years ago I tried to switch into EM and cold called some of the programs on that list. Some of the PDs ignored my emails and those same programs filled 0 spots. I wonder if they’d share the same sentiment today to give a professional courtesy email back.

Never been happier to not be in EM. Life’s too short to not have control of your nights and weekends.

What field are you in?

 

[EctopicFetus]

It is funny cause on EM Docs the ACEP penis breaths are like locums is still ok for now, and people can get jobs etc. They fail to look at where this current class will be when they finish residency in 2026/2027. It’s not about where you are today it IS about where you will be when you can actually get a job. At that time another 9k residents will graduate And take jobs in front of you. most will be in their early 30s and all but a few will be under 40.

Those folks will have high debt, relatively low pay with pay trickling down. I doubt we see a full on collapse in wages. Medicine is unlikely to get better. APP and envision will have a major event which I am not smart enough to see the final outcome. USACS wont be able to pay off their $700M debt and will “restructure” their debt and DbAg and co will take out an ad in the ACEP journal touting how amazing their company is. They will restructure their debt at 14% and make analogies to you taking out a mortgage on your home.

These grads will be traveling 90-120 mins from home or fully moving to towns they want no part of cause they wont have other transferable skills And will be riddled with debt. Eventually some of these folks will sadly have mental health breaks and give up on medicine altogether or go be medspa directors making $500 a pop from noctors pursuing their aesthetic medicine passions and doing Botox and juvederm. I would discourage anyone from going into EM unless you want a future full of misery, disrespect, moral injury and diminishing pay.

 

[NYEMMED]

The fact that some NYC programs did not fill at ALL is scary and quite sad :/

I mean, wow…for example, St Barnabas Hosp is an amazing program in the Bronx. I’m literally floored that it didn’t fill and has so many spots available.

Problem is, why would people want to go to Barnabas. It is a long standing great program. But it’s completely run on the backs of residents, IE place IVs, push patients around the department and to CT etc, giving meds, doing all the ancillary tasks themselves etc…

They can just go to a program that treats them like a resident physician…

 

[Splenda88]

Is IM (hospitalist) better than EM now since one can make 300k/yr in IM without killing oneself?

 

[BicepsTriceps]

Is IM (hospitalist) better than EM now since one can make 300k/yr in IM without killing oneself?

I think it's more about flexibility and freedom.

Hospitalist jobs are everywhere. It's rare to find a hospital without some openings.

Don't want to do that?

Jump to outpatient.
Start your own business.
Med spa lol.
If you're young enough go back to fellowship which opens many options.

 

[sylvanthus]

Hello friend. I'll take some heat from the crowd for saying this, but take everything you see on here (as well as reddit, Twitter, ect.) with a grain of salt. It is SDN, of course. Sorta a red flag when someone tells you to grow thick skin when they haven't even met you in real life. The reality is no one can 100% be certain with how EM could change in the coming years. I doubt EDs will just cease to exist, and I'm doubtful institutions will allow their trigger/rapid response and trauma teams to be ONLY run by midlevels. The world changes- we could have another pandemic worse than COVID, WWIII could break out, or the US healthcare system could totally change. Maybe some of the less-established residencies fold after this- after all, their model depends on getting residents. As for working weekends and holidays, anyone who wants to care for acuity on a regular basis has to do that. Trauma surgeons, anesthesiologists, critical care docs, ect. Idk what the proportion is compared to EM docs, but I think it is unfair to single out EM in that regard. EM has its stressors and burnout factors, but last I checked, so does surgery and FM. Granted I'm only an M1 (who was a paramedic in my prior life), so what do I know? The best advice I can give is go into med school with an open mind (my mother told me that once or twice). Sure, a lot of med students change their specialties; a lot also do not change their specialties and stick to their passion. You and I will go in, shadow different specialties here and there, rotate through the big ones M3 year, and make a decision end of M3 year. So for heavens sake, if you are at the end of M3 year and you can ONLY see yourself doing EM and nothing else, then by God please apply EM. Also, we have the EM/IM, EM/IM/CC, and EM/anesthesia programs out there. Far and few, but they could grow. And there doesn't seem to be good consensus on how healthcare utilizes these dual specialized physicians.

Dude your an m1 critizing EM attendings. Go learn the krebs cycle.

 

[HemorrhagicShock]

Let's be clear about one idiosyncrasy of the entire residency approval process. It's not a CMG, or a SDG, or ACEP, or ABEM that controls this in any meaningful way.

The ACGME is what accredits and gives the stamp of approval to residencies. It's the ACGME EM RC members' job to police this and set up criteria that must be met in order for an institution to start a residency. The fact that any HCA trash-heap can start a residency is due to the criminally low bar for graduation requirements.

Thus we should hold them accountable. Here they are:

Linda Regan, MD - Chair
Jan Shoenberger, MD - Vice Chair
Rebecca Boyer, MD - Resident Member
Kimberly Richardson, MA - Public Member
David A. Caro, MD,
Brian Clemency, DO
Paul Ishimine, MD
Alan Janssen, DO
Eric Lavonas, MD, MS
Tiffany E. Murano, MD
Melissa Platt, MD, FACEP, FAAEM
Jill Stefanucci-Uberti, DO
Michael Wadman, MD

Ex-Officios
Melissa Barton, MD
Sarah Brotherton, PhD
Karissa Delgado
Jonathan Fisher, MD
Christopher Zabbo, DO, FACEP, FAAEM, FACOEP

This is all public data that can be accessed online via Review Committee Members

Do any of you work with them? Ask them what's going on in these meetings. Do any of you have personal connections to them? Get a beer with them and tell them to fight for their specialty. If any of them are reading this, where does your internal compass point given the dismal results of this year's match?

 

[cyanide12345678]

Dude your an m1 critizing EM attendings. Go learn the krebs cycle.

M1 - 7 years away from having an attending job.

Let’s see …. That’s 3000 x 7 = 21000 graduates ahead of them.

Does anyone see 21000 ER doctors retiring in the next 7 years? Or does anyone see 21000 jobs opening up in 7 years?

Your total ER workforce in the US is 46k. Literally based on current residency expansion number, you will increase work force by 50 percent in less than 8 years.

I mean sure…the guy can do EM. If he/she doesn’t find a job, oh well then.

 

[JacobMcCandles]

Is IM (hospitalist) better than EM now since one can make 300k/yr in IM without killing oneself?

At least at our hospital, our hospitalists have the worse job in the hospital. They’re employed by a CMG so they’re severely understaffed and overworked and seems like every week another one is quitting.

 

[JacobMcCandles]

Christopher Zabbo, DO, FACEP, FAAEM, FACOEP

I bet this guy puts every last letter after his name on every email. And I bet he goes by Christopher and not Chris.

Edit: He co-owns one of ‘those’ clinics: Rhode Island Location, Dr Christopher Zabbo, Dr Michael Kelly — Anderson Longevity Clinic ®

Yeah, he doesn’t care about pit docs. Maybe he should take some more testosterone to have the balls to stand up for what’s right.

PS: Judging by his picture their hair rejuvenation is a sham.

 

[Splenda88]

At least at our hospital, our hospitalists have the worse job in the hospital. They’re employed by a CMG so they’re severely understaffed and overworked and seems like every week another one is quitting.

That is a bad place. The good thing is that hospitalist can find an ok job anywhere in the country right now.

 

[miacomet]

Problem is, why would people want to go to Barnabas. It is a long standing great program. But it’s completely run on the backs of residents, IE place IVs, push patients around the department and to CT etc, giving meds, doing all the ancillary tasks themselves etc…

They can just go to a program that treats them like a resident physician…

It's a great program if you want to stay in NYC.
It's not a great program if you want to work in a community hospital where patient satisfaction is king and you can't consult for every patient.

 

[Kuratz]

I hope for the physicians’ sake and selfishly for my future health care that someone steps the **** up and leads EM out of this mess. I really truly feel for EM docs, they do NOT seem to be having a fun time. I thank god that I matched into Rads which is tolerable for a lengthy career in its current state. But the amount of nonsense coming into the ED at 1am is purely ridiculous from a societal perspective and there isn’t really agency from physicians to do anything about it. We’re lucky to have pretty darn good ED docs at our hospital who I’m sure shield us from some of the dumb stuff and yet every night is filled with people who have no business being there. We’re fortunate in Rads because that 70 year old dizzy lady’s head CT takes 3 minutes to read but I can’t imagine dealing with those patients and their unrealistic demands/expectations night in, night out.

Hoping most those spots don’t end up filling. I won’t hold my breath.

 

[Kryptocoin]

There are some on social media blaming the ACEP workforce study for the disastrous match result. So, what's ACEP to do? Not do a study? Or worse, lie to future EM residents that all is well?

 

[southerndoc]

Afraid three-year
A French, physician maketh
because of the match

 

[RustedFox]

Afraid three-year
A foreign, physician maketh
because of the match

2nd line has eight syllables.

Apollyon; don't you have some English-language history inside knowledge of this-or-something-like-this?

 

[sylvanthus]

At least at our hospital, our hospitalists have the worse job in the hospital. They’re employed by a CMG so they’re severely understaffed and overworked and seems like every week another one is quitting.

Same, we have Sound as our hospitalists. They have one doc at night covering nearly 200 patients while still taking admits. Ffffffffff that.

 

[EctopicFetus]

M1 - 7 years away from having an attending job.

Let’s see …. That’s 3000 x 7 = 21000 graduates ahead of them.

Does anyone see 21000 ER doctors retiring in the next 7 years? Or does anyone see 21000 jobs opening up in 7 years?

Your total ER workforce in the US is 46k. Literally based on current residency expansion number, you will increase work force by 50 percent in less than 8 years.

I mean sure…the guy can do EM. If he/she doesn’t find a job, oh well then.

Job market is already tight. Imagine in 7 years. Will be unprecedented and few fellowship options. How many CC docs can EM punch out? Many folks dont want EM trained people since they wont do pulm and thats where the $$$ is at for your employers.

 

[southerndoc]

2nd line has eight syllables.

Apollyon; don't you have some English-language history inside knowledge of this-or-something-like-this?

fixed

 

[RuralEDDoc]

What's even more shocking is that Kaiser Modesto filled all their spots, being 2 years old and having to ship their trauma and peds rotations to other hospitals. I think it's probably got to do with the high salary they're paying their residents....which last I checked was possibly the highest paid EM residency in the country. Kaweah Delta is certainly more established and has a much larger catchment than KP Modesto does.

Kaiser is known internationally. Can’t say the same for safety net hospitals. That’s gotta play a role.

 

[Siggy]

If just 2 of these programs could be shut down, emergency medicine in California might have a fighting chance. Ideally, an Inland Empire based program (RUHS, Desert, or Arrowhead) and Kaweah Delta should bite the bullet and close shop.

• Kaweah Delta Health Care District-CA (wow.... really misgauged their competitiveness)

The sad part is Arrowhead seemed to be a pretty solid program 10 years ago.

 

[Mbekweni]

So from a selfish perspective- let’s say someone has a nice plush SDG job that seems secure. Pay is great, work isn’t that bad. I’m thinking aside from CMS reimbursement cuts, no surprise billing act negotiation shenanigans impacting NOR then shouldn’t be the end of the world right? Medical directors will have people beating down the doors trying to get on the schedule at a shop that doesn’t suck, but I’m not seeing a future that’s horribly bleak for those already well established? Now if you are the 20,000th new grad wanting to practice in a CMG owned region you are toast…we can all agree on that.

 

[emergentmd]

When I stated EM 20 yrs ago with SDG, the job was great. Dealt with so many specialists the 1st 10 yrs when the job was still great, pay was great. Most hospital based specialists I encountered disliked their jobs with the hospitalists being the worse followed by surgeons. I suspect this has not changed an probably worse. Yes EM is becoming a pretty terrible job evidenced by many of my old partners leaving their hospital based jobs.

But don't fool yourself b/c many hospital based specialists suck. I know anesthesiologists, surgeons, Cards, OB who complained 10 yrs ago and still complaining.

So my advice to all EM docs

1. Med student - if you really cant do anything else EM, then go for it. You still will make 200+/hr. The job is hard, and not many docs will work for much less. If EM is not your love, then go into an office based job. Any hospital based job (OB, Hospitalists, surgeons, etc) suck when you are beholden to CMGs/hospitals.
2. Residents - You are stuck and will be an EM doc no matter what you do. The job market currently is hot. Go out, make 300+/hr, pay off loans, and then think early about an exit plan. Having options allows working in EM much more bearable.
3. Attendings - See #2, but look to diversify your income./career ASAP. Network, diversify your income as you have the time and $$$ to pursue this. FSERs ownership with a truly doctor owned group is fantastic, better than almost any other fields you can go into, but the golden age could very well be over. Start looking at passive income be it RE, dividend funds, other unrelated careers. You have the time and money to pursue other income/jobs that most other specialists in the house of medicine can not. Once our SDG was taken over by a CMG, I went hard into real estate then FSER, and now I am looking into a career in finance. Be a good moral person, work hard, make connections and there will be opportunists outside of medicine that seemingly falls into your lap. FSER and now finance were started from just networking.

 

[GonnaBeADoc2222]

LOL at people breathing sighs of relief they didn't go into EM.

EM is the canary in the coal mine, my brothers. This is coming for all of you.

Anesthesiology...CMGs already here, that CRNA machine go brrrrrrrrrrrrrrr...why would they pay you 500k when they can pay a CRNA 200k?

Psych...essentially the EM of 2013...hot now...was for the low performing medical students 10 yrs ago...online psych NP machine go brrrrrrrrr

Derm...being gobbled up by PE...RNs can do aesthetics LOL

Rads...you think CMS / insurance compensation gonna stay at same levels for the billion CTAPs I order from the ED?

 

[EctopicFetus]

When I stated EM 20 yrs ago with SDG, the job was great. Dealt with so many specialists the 1st 10 yrs when the job was still great, pay was great. Most hospital based specialists I encountered disliked their jobs with the hospitalists being the worse followed by surgeons. I suspect this has not changed an probably worse. Yes EM is becoming a pretty terrible job evidenced by many of my old partners leaving their hospital based jobs.

But don't fool yourself b/c many hospital based specialists suck. I know anesthesiologists, surgeons, Cards, OB who complained 10 yrs ago and still complaining.

So my advice to all EM docs

1. Med student - if you really cant do anything else EM, then go for it. You still will make 200+/hr. The job is hard, and not many docs will work for much less. If EM is not your love, then go into an office based job. Any hospital based job (OB, Hospitalists, surgeons, etc) suck when you are beholden to CMGs/hospitals.
2. Residents - You are stuck and will be an EM doc no matter what you do. The job market currently is hot. Go out, make 300+/hr, pay off loans, and then think early about an exit plan. Having options allows working in EM much more bearable.
3. Attendings - See #2, but look to diversify your income./career ASAP. Network, diversify your income as you have the time and $$$ to pursue this. FSERs ownership with a truly doctor owned group is fantastic, better than almost any other fields you can go into, but the golden age could very well be over. Start looking at passive income be it RE, dividend funds, other unrelated careers. You have the time and money to pursue other income/jobs that most other specialists in the house of medicine can not. Once our SDG was taken over by a CMG, I went hard into real estate then FSER, and now I am looking into a career in finance. Be a good moral person, work hard, make connections and there will be opportunists outside of medicine that seemingly falls into your lap. FSER and now finance were started from just networking.

Ill say this we agree on most of this BUT.... the $200/hr isnt gonna last. You are a business savvy guy. Fast forward to 2030.. I have docs banging down my door to work. The 10k too many docs arrives and we have a 20% surplus of EM trained docs. Many of the FP folks have been pushed out but reality is some of them are fine when working in the sticks. Dont forget the MLP widget machine is not slowing down either.

So I am a hospital or CMG and..... well i need to make more money. My physician staffing needs are met and some of these docs decided they want to work more because that trip to Hawaii is coming up. Guess what as a smart business owner I dont hire for 100% of what the docs want I hire for 110-120% of the hours so if one leaves I already have my fill ins in place. I have 2 options. I let the docs know how insurance/cms/NSA or whatever boogeyman is coming is hurting our collections and the only way to keep the ED sustainable is a small cut in pay. We go from 180/hr to 170. 3000 new hires are knocking at my door. I figure they are desperate chaps. Hmmmm.. They trained in BFE hospital I couldnt ID on a map and I think they will work PRN for 160/hr. And so pay goes down the drain.

The mantra of docs will only work for 200/hr may hold true for now in many places but USACS is paying 130/hr in chicago. not a LCOL place. Denver is similar. Thats what happens to pay when a market is oversaturated. Why are most of the high paying jobs not in Austin, New York, LA etc. Cause they dont have to pay. eventually even these hinterland craphole hospitals will have docs cause they will simply pay more. i know docs making $300/hr in fairly cush jobs but thats because no one wants to work at a hospital 3 hours outside of a decent airport.

Eventually more and more people will give in to their must haves and sure there will be a job in ND that pays but they will demand you live nearby so you dont miss shifts due to weather.

Re #2 and #3. 100%. I actually really enjoy my job and im confident being on good financial footing makes it all the more tolerable knowing i deal with the nonsense because I want to and not because I have to. Within the first 5-7 years if you arent at least legit leanFire you are doing it wrong.

Find whatever you like RE, stocks, day trading, med spa, small business ownership that doesnt require a lot of hands on, marry rich whatever. Find some solid passive income.

 

[bronx43]

Psych...essentially the EM of 2013...hot now...was for the low performing medical students 10 yrs ago...online psych NP machine go brrrrrrrrr

Derm...being gobbled up by PE...RNs can do aesthetics LOL

Rads...you think CMS / insurance compensation gonna stay at same levels for the billion CTAPs I order from the ED?

Psych and derm are not the same as EM. Even if you flood the market with midlevels, there’s a floor for how low the field can go simply due to the intrinsic demand by cash payers (or even privately insured patients) for a pedigreed doctor. Worst comes to worst you can hang a shingle and outcompete the gaggle of NPs next door. Ultimately, they create their own demand unlike EM or anesthesia which is plug and play.

There’s no indication rads reimbursement will go anywhere.

 

[GonnaBeADoc2222]

Psych and derm are not the same as EM. Even if you flood the market with midlevels, there’s a floor for how low the field can go simply due to the intrinsic demand by cash payers (or even privately insured patients) for a pedigreed doctor. Worst comes to worst you can hang a shingle and outcompete the gaggle of NPs next door. Ultimately, they create their own demand unlike EM or anesthesia which is plug and play.

There’s no indication rads reimbursement will go anywhere.

Psych and Derm are ripe for PE profiteering.

There was no indication EM reimbursement would go anywhere...until it did.

 

[bronx43]

Psych and Derm are ripe for PE profiteering.

There was no indication EM reimbursement would go anywhere...until it did.

PE is much less devastating for outpatient. Can they cause damage? Sure, but when any derm or psychiatrist can just hang a shingle and compete by pedigree and word of mouth, they’re fine.

 

[VA Hopeful Dr]

PE is much less devastating for outpatient. Can they cause damage? Sure, but when any derm or psychiatrist can just hang a shingle and compete by pedigree and word of mouth, they’re fine.

Yep. Either one could open up where I am and be booked out 6 months by the end of summer.