zero unfilled positions this year

4 EM/IM spots

where can we find this information?

Only because I am lazy and do not want to do the leg work, this ever happen before?

danzman said:

Only because I am lazy and do not want to do the leg work, this ever happen before?

Click to expand...

This is easy to explain. Training spot expansion is not occurring due to lack of funding from government sources, and hospitals are coping by increasing the number of NPs, PAs, and CRNAs they are hiring.


http://www.youtube.com/watch?v=xxQB1R8AF4A

bulgethetwine said:

This is easy to explain. Training spot expansion is not occurring due to lack of funding from government sources, and hospitals are coping by increasing the number of NPs, PAs, and CRNAs they are hiring.


http://www.youtube.com/watch?v=xxQB1R8AF4A

Click to expand...

don't know man, 1688 spots....maybe we should calm down with the expansion for awhile...half the programs I interviewed at are expanding, lets not expand ourselves out of a livlihood.

bulgethetwine said:

This is easy to explain. Training spot expansion is not occurring due to lack of funding from government sources, and hospitals are coping by increasing the number of NPs, PAs, and CRNAs they are hiring.


http://www.youtube.com/watch?v=xxQB1R8AF4A

Click to expand...

No, no, I get all that. I mean has there ever been a match where there are no unfilled EM spots before the scramble? Seems like I always see a handful talked about.

Braves123 said:

don't know man, 1688 spots....maybe we should calm down with the expansion for awhile...half the programs I interviewed at are expanding, lets not expand ourselves out of a livlihood.

Click to expand...

Unlikely. The most recent projection is that, for the foreseeable future, we won't catch up with EM residency graduates to fill EP spots.

Braves123 said:

don't know man, 1688 spots....maybe we should calm down with the expansion for awhile...half the programs I interviewed at are expanding, lets not expand ourselves out of a livlihood.

Click to expand...

Probably still wouldn't be enough spots if the mid-levels weren't taking ER jobs.

Two questions 1. what does it mean that there were no unfilled positions? Obviously it does not mean that EM is as competitive as derm or ortho. Does it just then mean that it's popular?

2. Am I the only person that doesn't give a $hit about whether mid-level practitioners work in the ED? Do I really want to be seeing all the most boring urgent-care plus level patients and reporting to an attending the rest of my life? No! Their jobs are fundamentally different from mine. And if these fine ladies and gentleman will see the boring patients, so that I can see more interesting crap--welcome aboard! I think turf wars make sense when you're fighting over the same turf. The low-acuity ED patient is turf that I will readily cede.

member11223344 said:

Two questions 1. what does it mean that there were no unfilled positions? Obviously it does not mean that EM is as competitive as derm or ortho. Does it just then mean that it's popular?

2. Am I the only person that doesn't give a $hit about whether mid-level practitioners work in the ED? Do I really want to be seeing all the most boring urgent-care plus level patients and reporting to an attending the rest of my life? No! Their jobs are fundamentally different from mine. And if these fine ladies and gentleman will see the boring patients, so that I can see more interesting crap--welcome aboard! I think turf wars make sense when you're fighting over the same turf. The low-acuity ED patient is turf that I will readily cede.

Click to expand...

Clearly you haven't worked with enough PAs that aren't up to snuff.... but yet you're responsible for.

I'll cede the turf... then let them shoulder the liability, too.

RustedFox said:

Clearly you haven't worked with enough PAs that aren't up to snuff.... but yet you're responsible for.

I'll cede the turf... then let them shoulder the liability, too.

Click to expand...

...also, the poster must not be aware of the CRNAs or DNPs (hell, even NPs!)

HH

member11223344 said:

Two questions 1. what does it mean that there were no unfilled positions? Obviously it does not mean that EM is as competitive as derm or ortho. Does it just then mean that it's popular?

2. Am I the only person that doesn't give a $hit about whether mid-level practitioners work in the ED? Do I really want to be seeing all the most boring urgent-care plus level patients and reporting to an attending the rest of my life? No! Their jobs are fundamentally different from mine. And if these fine ladies and gentleman will see the boring patients, so that I can see more interesting crap--welcome aboard! I think turf wars make sense when you're fighting over the same turf. The low-acuity ED patient is turf that I will readily cede.

Click to expand...

At the residency programs in my area, PAs staff the pods right beside residents--they don't see resus cases, but they'll see high-acuity stuff like NSTEMIs, possible stroke (outside TPA window), abdominal pain, etc.

I think you're a fool if you don't consider encroachment a threat.

member11223344 said:

Two questions 1. what does it mean that there were no unfilled positions? Obviously it does not mean that EM is as competitive as derm or ortho. Does it just then mean that it's popular?

2. Am I the only person that doesn't give a $hit about whether mid-level practitioners work in the ED? Do I really want to be seeing all the most boring urgent-care plus level patients and reporting to an attending the rest of my life? No! Their jobs are fundamentally different from mine. And if these fine ladies and gentleman will see the boring patients, so that I can see more interesting crap--welcome aboard! I think turf wars make sense when you're fighting over the same turf. The low-acuity ED patient is turf that I will readily cede.

Click to expand...

You assume that mid-levels will be restricted to boring lower acuity patients. This assumes that hospital administrators and contract holding MDs can be trusted to maintain the higher quality and safety provided by board certified EM specialists even though they can make much more money with lower cost providers.

With the growth of risk based ACOs and the priority of reducing cost of care, I would not bet a lot of money on that assumption. Imagine instead an ED with a medical director, available by phone for tough cases that the PA is too weak to handle. In this ED of the future, PAs provide *all* the ED care including resuscitation. There are already plenty of EDs where the PAs see all levels of acuity without direct supervision. If the PA run ED becomes standard, the market for BC EM is already more than saturated.

Be afraid. Be very, very, afraid.

nevermind.

Haemr Head said:

You assume that mid-levels will be restricted to boring lower acuity patients. This assumes that hospital administrators and contract holding MDs can be trusted to maintain the higher quality and safety provided by board certified EM specialists even though they can make much more money with lower cost providers.

With the growth of risk based ACOs and the priority of reducing cost of care, I would not bet a lot of money on that assumption. Imagine instead an ED with a medical director, available by phone for tough cases that the PA is too weak to handle. In this ED of the future, PAs provide *all* the ED care including resuscitation. There are already plenty of EDs where the PAs see all levels of acuity without direct supervision. If the PA run ED becomes standard, the market for BC EM is already more than saturated.

Be afraid. Be very, very, afraid.

Click to expand...

I am very afraid!!!! I think we should take a hint from gas and stop our rampant expansion

As an ER PA who went back to medical school I felt I had to comment. I went back to school because I felt I needed to learn more about medicine (physiology, etc) to provide better patient care. I am glad I did. The responsibility I had depended on the ER I worked. I worked in small rural ER's where I did everything. I worked at a 110 bed L1T center and I did urgent care stuff. However, you should know that PA's are not pushing to "encroach" on the MD's turf. We are not like NP's. We feel we "need" supervision but are still able to act as a valuable part of the team. The philosophy will never change. Sure, we have lobbied for prescription privileges and such but only to make the team run more efficiently.
Also, the main reason ER applicants are being squeezed is because there are more graduating US medical students and no increase in EM residency spots. This is well known.
Hope to match ER 2013

I don't buy it. I think being super afraid of changes in healthcare, whether it's the inclusion of mid-level practitioners, or new technology, or women becoming physicians in larger numbers, or whatever, is a mistake. Will board certified EM docs have to innovate to set themselves apart? Probably. Maybe doing more administrative work, or research (in academic jobs), or involving themselves in various oversight activities. But I really don't think that being "very, very afraid" of PAs or NPs is going to accomplish anything at all. Nobody argues that a Trauma PA is the same thing as a trauma surgeon. We have a responsibility to perhaps set stronger parameters as a field for what are appropriate tasks for PAs or NPs to handle--something that I think is well worth a lot of EP advocacy. But I refuse to feel threatened by mid-level pracitioners as a matter of principle.

RustedFox said:

Clearly you haven't worked with enough PAs that aren't up to snuff.... but yet you're responsible for.

I'll cede the turf... then let them shoulder the liability, too.

Click to expand...

Oh, and interns are all up to snuff on July 1st? Pssshhhh.

member11223344 said:

Oh, and interns are all up to snuff on July 1st? Pssshhhh.

Click to expand...

Pssh.


Intern =/= PA =/= BC EM.

Even as an intern, some of the things that I heard from some of the "veteran" PAs were stunningly stupid. A sampling:

"I thought that babies under 9 months couldn't get allergies because they still have mom's antibodies to protect them."

"That GI bleeder wouldn't have bled again if you've have given him Zofran first."

"He can't have a PE. He's taking coumadin."

Granted, I've worked with some real rockstar PAs. Most don't completely suck at life, but many have LARGE gaps in their basic science knowledge. I don't want to be responsible for their eff-ups.

Some movie quote about "great power and great responsibility" here.

The power of autonomy should come with commensurate responsibility.

member11223344 said:

I don't buy it. I think being super afraid of changes in healthcare, whether it's the inclusion of mid-level practitioners, or new technology, or women becoming physicians in larger numbers, or whatever, is a mistake. Will board certified EM docs have to innovate to set themselves apart? Probably. Maybe doing more administrative work, or research (in academic jobs), or involving themselves in various oversight activities. But I really don't think that being "very, very afraid" of PAs or NPs is going to accomplish anything at all. Nobody argues that a Trauma PA is the same thing as a trauma surgeon. We have a responsibility to perhaps set stronger parameters as a field for what are appropriate tasks for PAs or NPs to handle--something that I think is well worth a lot of EP advocacy. But I refuse to feel threatened by mid-level pracitioners as a matter of principle.

Click to expand...

Look, innovation and change is good. I agree with you. Our skill set will continue to evolve and expand... The issue at hand here is that 'management' treats them like independent practitioners, but they have minimal to no culpability. At my shop, we have PAs see a lot of the fast track stuff. A lot of it. They only staff one MD/DO at a time, and he/she is supposed to be signing off and supervising the PA's every patient. There's no way its possible; thus, the MD/DO is acting purely as a "liability offset", and well... just read some of the quotes in my above post to see why you SHOULD be worried.

Like I said, let 'em see their own patients with autonomy... but when they make mistakes... let 'em eat them too. Then, we'll see what happens with who is the 'better provider for the money'.

We can agree on the point that there should be better oversight so that EPs are not left holding the bag when less educated/experienced individuals are running the show. As for the rest of it--if you took individual quotes out of context for any group, you'd come up with dumb crap. In fact, taking board certified emergency physicians' comments out of context and laughing about how stupid they are is called "Medicine Rounds" at my institution. Hardly proof positive of any particular deficiencies.

member11223344 said:

We can agree on the point that there should be better oversight so that EPs are not left holding the bag when less educated/experienced individuals are running the show. As for the rest of it--if you took individual quotes out of context for any group, you'd come up with dumb crap. In fact, taking board certified emergency physicians' comments out of context and laughing about how stupid they are is called "Medicine Rounds" at my institution. Hardly proof positive of any particular deficiencies.

Click to expand...

Okay, that's fine.... my n=1.

However, there are several posters above me (many of them very much more seasoned/experienced than me) who seem to echo my sentiments.

bulgethetwine said:

This is easy to explain. Training spot expansion is not occurring due to lack of funding from government sources, and hospitals are coping by increasing the number of NPs, PAs, and CRNAs they are hiring.


http://www.youtube.com/watch?v=xxQB1R8AF4A

Click to expand...

Great video.. hilarious..

Curious.. how many of you guys profit off of the PAs. I do.. Like anything else there are good ones and bad ones. We have our little group and we know who needs extra supervision. I do think the NPs are more of an issue. Most dont go to school full time like PAs. They work full time and do their NPs on the side. Thats a scary proposition to me.

Yeah... wasn't this supposed to be about how there were no unfilled positions in the match this year...? I was surprised to see it and very thankful I didn't have to SOAP. EM is great, more peeps are interested in it and as mentioned above, the applicant pool continues to grow without an real expansion in spots. That's probably part of the explanation, but I'm sure there's more.

Friday can't come quickly enough

Yeah, honestly I was surprised there were NO spots this year, not counting the EM/IM spots. I had a gut feeling that last year was just way more competitive, but for there to be absolutely no spots caught me off guard. Although I think that what was more surprising was the number of slots for other specialties too. Only 51 medicine slots didnt fill, 123 med pre-lims (seems like a small amount for all the scramblers), no ortho, 2 neurosurg, 2 ENT, 0 PM&R. Perhaps the most surprising stat was actually there were 11 PGY-2 Derm spots and 75 PGY-2 Rads spots... Either way, the numbers this year don't favor the new SOAP process.

Hopefully those that do have to "SOAP" will have even better luck next year. I feel just awful for the people I know that are going through the process this week...

I was just informed that the correct nomenclature for NPs, PAs, and midwives is "Advanced Practice Providers."
They do not feel they are "midlevel" anymore.
Also, there's a push from PAs to be known as "Physician Associates." They do not assist physicians. They associate with them.
I've also met a few nurses who wish to be called, "Clinicians."

Ruprict said:

Yeah... wasn't this supposed to be about how there were no unfilled positions in the match this year...? I was surprised to see it and very thankful I didn't have to SOAP. EM is great, more peeps are interested in it and as mentioned above, the applicant pool continues to grow without an real expansion in spots. That's probably part of the explanation, but I'm sure there's more.

Friday can't come quickly enough

Click to expand...

Welcome to SDN.

How many children with ADHD does it take to change a lightbulb ? ....


... wanna ride bikes ?

Muscletoe said:

I was just informed that the correct nomenclature for NPs, PAs, and midwives is "Advanced Practice Providers."
They do not feel they are "midlevel" anymore.
Also, there's a push from PAs to be known as "Physician Associates." They do not assist physicians. They associate with them.
I've also met a few nurses who wish to be called, "Clinicians."

Click to expand...

And then of course there are the nurses who are now getting a PhD of some kind and referring to themselves as Doctor in hospitals/clinics. It is certainly not untrue, but definitely misrepresentation... I'll go ahead and admit that I'm on the side of the fence that thinks this is not ok.

RustedFox said:

Welcome to SDN.

How many children with ADHD does it take to change a lightbulb ? ....


... wanna ride bikes ?

Click to expand...

Especially true in an EM forum.

Single patient encounter last week:

PA to patient: "we get the exact same education as doctor's, we just do it in less time. otherwise, we're exactly the same"

DO to patient: "DO's have a much better understanding of how the body works than MD's. MD's focus more on drugs and surgery"

Patient: "That's what I thought I heard on internet, just making sure"

Per the zero unfilled EM spots. Pretty much expect that to be the norm from here on out for EM and a lot of other specialties. Increased interest in EM as it is often viewed as a lifestyle specialty (??), more students, same number of training spots. Easy math.

aznsuperm3 said:

Especially true in an EM forum.

Click to expand...

Yuuuup.

I love what I do.

DreamingTheLive said:

Single patient encounter last week:

PA to patient: "we get the exact same education as doctor's, we just do it in less time. otherwise, we're exactly the same"

DO to patient: "DO's have a much better understanding of how the body works than MD's. MD's focus more on drugs and surgery"

Patient: "That's what I thought I heard on internet, just making sure"

Per the zero unfilled EM spots. Pretty much expect that to be the norm from here on out for EM and a lot of other specialties. Increased interest in EM as it is often viewed as a lifestyle specialty (??), more students, same number of training spots. Easy math.

Click to expand...

For some reason your tales seem very tall on both aspects....ancedotes....

Makati2008 said:

For some reason your tales seem very tall on both aspects....ancedotes....

Click to expand...

Oddly enough, I've heard remarkably similar things out of the mouths of the DO/PA/NP squads in my neck of the woods.


You will see... oh, you will see...

Makati2008 said:

For some reason your tales seem very tall on both aspects....ancedotes....

Click to expand...

Yes, it was an anecdote. Good diagnostic skills.

DreamingTheLive said:

Yes, it was an anecdote. Good diagnostic skills.

Click to expand...

Good job(sarcasm). Seems like you have an issue with both D.O.'s and P.A.'s both. Hopefully you get over those quickly since it's all about our patients' in the end.

Best of luck.

seems like students think EM is a good place to be..

<---- just happy to have a job come July!

RustedFox said:

Oddly enough, I've heard remarkably similar things out of the mouths of the DO/PA/NP squads in my neck of the woods.


You will see... oh, you will see...

Click to expand...

PA- I have heard about colleagues doing this and I have personally wanted them fired. This has been rare over the past 7 years or so I can count the number on one hand.

NP-I actually posted about one saying she was a Doctor over and over at dinner and I was too tired/stupid to catch on and the wife actually caught it.(After I googled the name of her school when I got home it was a DNP program go figure...). Also have had some bad outcomes personally with that bunch so I don't care for them...

DO-I am in school to be one and I believe that some of the "hardcore" guys would say something like that. The great majority of D.O.'s practice just like M.D.'s and you cannot tell the difference. Personally I had the choice to go M.D. (I really dislike our state school at home) and picked D.O. instead.

Just seemed odd that this all happened this week with the previous poster to me. Also I guess I am looking at the post and it deivated WAY away from what it was originally about.

Best of luck

DreamingTheLive said:

Single patient encounter last week:


DO to patient: "DO's have a much better understanding of how the body works than MD's. MD's focus more on drugs and surgery"

Patient: "That's what I thought I heard on internet, just making sure"

Click to expand...

This drives me nuts, too. Let me be clear: I have no issues with DOs at all. I was trained by and work alongside many DOs. They're great. Period. Period.

What does kill me is that the public at large likes to believe that while MDs are just soulless scientists that like "drugs and surgery" (oddly enough, I *have* heard that exact same phrase uttered to compare MD/DO before), that DOs like to understand the white magic of "how the body works as a whole" (whatever that means). It really does boil down to that. The public likes to use words like "holistic", "natural", and other terms that make them feel fuzzy... and if you're the master of things that are fuzzy and warm, then you're somehow more "in tune to"... whatever... and are thus more capable of ... whatever.

Medicine is, needs to be, and should be based on logic, reason, and objective fact. What the public wants is... white magic, because "science is hard".

RustedFox said:

Oddly enough, I've heard remarkably similar things out of the mouths of the DO/PA/NP squads in my neck of the woods.


You will see... oh, you will see...

Click to expand...

RustedFox said:

This drives me nuts, too. Let me be clear: I have no issues with DOs at all. I was trained by and work alongside many DOs. They're great. Period. Period.

What does kill me is that the public at large likes to believe that while MDs are just soulless scientists that like "drugs and surgery" (oddly enough, I *have* heard that exact same phrase uttered to compare MD/DO before), that DOs like to understand the white magic of "how the body works as a whole" (whatever that means). It really does boil down to that. The public likes to use words like "holistic", "natural", and other terms that make them feel fuzzy... and if you're the master of things that are fuzzy and warm, then you're somehow more "in tune to"... whatever... and are thus more capable of ... whatever.

Medicine is, needs to be, and should be based on logic, reason, and objective fact. What the public wants is... white magic, because "science is hard".

Click to expand...

Agreed. If some of the warm and fuzzy stuff has some EBM to back it up then I am prone to listen o/w I am a firm believer of what you said in the bolded.

RustedFox said:

Medicine is, needs to be, and should be based on logic, reason, and objective fact. What the public wants is... white magic, because "science is hard".

Click to expand...

As Stephen Hawking said, "Mysticism is for those who can't do the math."

Muscletoe said:

I was just informed that the correct nomenclature for NPs, PAs, and midwives is "Advanced Practice Providers."
They do not feel they are "midlevel" anymore.
Also, there's a push from PAs to be known as "Physician Associates." They do not assist physicians. They associate with them.
I've also met a few nurses who wish to be called, "Clinicians."

Click to expand...

Paraphrasing from my favorite You tube video:

All of the above titles are akin to a polished turd. It's still a turd.

And quite calling yourself "clinician", or physician associate, or whatever the hell you want to be called to disguise the fact you're not a ****ing doctor.

bulgethetwine said:

Paraphrasing from my favorite You tube video:

All of the above titles are akin to a polished turd. It's still a turd.

And quite calling yourself "clinician", or physician associate, or whatever the hell you want to be called to disguise the fact you're not a ****ing doctor.

Click to expand...

This kills me too. I say: put 'em to the test.

I'll start calling them "Doctor" when they can pass STEP 1... 2 CK, 2 CS, and 3 (or the DO equivalent). Other than that... GTFO.

RustedFox said:

Oddly enough, I've heard remarkably similar things out of the mouths of the DO/PA/NP squads in my neck of the woods.


You will see... oh, you will see...

Click to expand...

Waaiiiiittttt. This is totally different.

I have trained beside and work with lots of D.O.s. I don't notice any tangible difference between our training/skill/ability. Any differences reflect our commitment to our careers, not our base degree.

This is *FAR* different from the debate of the place that NPs and PAs are trying to assume.

NPs and PAs are trying to grab ca$h after two extra years of nursing, want to be called doctor, and mostly are constantly agitating for more and more underserved autonomy.

D.O.s are doctors. They deserve to be called Dr. xxxx in my opinion.

bulgethetwine said:

Waaiiiiittttt. This is totally different.

I have trained beside and work with lots of D.O.s. I don't notice any tangible difference between our training/skill/ability. Any differences reflect our commitment to our careers, not our base degree.

This is *FAR* different from the debate of the place that NPs and PAs are trying to assume.

NPs and PAs are trying to grab ca$h after two extra years of nursing, want to be called doctor, and mostly are constantly agitating for more and more underserved autonomy.

D.O.s are doctors. They deserve to be called Dr. xxxx in my opinion.

Click to expand...

I agree wholeheartedly. I was unclear. I was specifically referring to the "we concentrate more on how the body works together as a whole" psalm that (some) of them chant. See my post above where I said - "I have no problems with DOs, period. Period."

White magic. We have a squad around these parts that's particularly wacky. I can always tell who the PCP is when one of their patients comes to the ED and the medication list includes "cinnamon", "lotus extract"... .... crimson and clooooo-verrr.... whatever.

Ohhh, oh... one more:

This whole notion of "detoxifying the colon" (liver/kidneys/whatever). I've never seen a plausible mechanism for this, yet there are a lot of white mages out there peddling their products, etc. This drives me nuts.


EDIT: Sorry, this was intended for another thread which had gone off-topic towards "things that patients say/do to drive us freaking batty". Good enough to stay here, though.

i agree w/ the PA remarks... i am glad that my large, democratic, multistate group keeps MLP's in the fast track areas only and requires MD supervision of all MLP cases... and yes, calls them MLP's

i too have heard some real zingers from PA/NP's... and had to clean up some awful messes. i really wish the concept of "PA residency" would spread more, to at least put new grads on a better ground before they're working just semi-supervised in a place like an ED where you can and will see ANYTHING

la gringa said:

i agree w/ the PA remarks... i am glad that my large, democratic, multistate group keeps MLP's in the fast track areas only and requires MD supervision of all MLP cases... and yes, calls them MLP's

i too have heard some real zingers from PA/NP's... and had to clean up some awful messes. i really wish the concept of "PA residency" would spread more, to at least put new grads on a better ground before they're working just semi-supervised in a place like an ED where you can and will see ANYTHING

Click to expand...

I could go on and on with the nuggets of dumb that I've heard... but that one about the antibodies and allergies really, really gets me. Antibodies.... don't... protect... against... herrrrp...de....derrrrp.... IgE.... cross-linking...! ! ! Graaaah !!!111!!