200+ Unfilled EM Spots

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True. I guess when you have NPs ordering every unnecessary lab and consulting every speciality and they’re cheaper to higher, applicants don’t feel motivated to have their jobs replaced with a midlevel. Sad, but the reality.
 
premed_mamba said:
I don’t know… even the IMG application rates were down 20%
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Yeah but I’m thinking more those that didn’t match in other fields. I’m sure for a lot of people being an EM doctor in America still beats being a doctor in many (not all) countries, even if it is not the best field right now in the US.
 
Apparently there are many applicants that didn't match as well, so I suspect this was just people avoiding certain residencies - but I imagine they will soap into those spots rather than go unemployed... Can anyone who's actually looked at the results confirm?
 
CajunMedic said:
There was more than one program that went completely unfilled, Even some big names that haven't had to SOAP in years had unfilled spots. A large margin of HCA programs went unfilled as well.
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Is there any way to find out which programs went completely unfilled?
 
That's actually better than I expected. 2702 out of 2921 filled. You'd think that the prospect of having no job at the end of residency would scare more people. Sadly, these matched applicants are going to regret their decisions in 3-4 years...
 
As stated already, unfilled spots doesn't mean anything. People erroneously believe this means that "less people are going into EM" which on the surface seems like a good thing given the projected oversupply. But these unfilled spots will be filled by (no offense) less qualified/stellar applicants in the SOAP. And they will be embraced with open arms especially by CMG residencies who are just looking for someone with a pulse to work for them. I would rather the spots be filled by people who truly want to do EM and have competitive applications, because then we are in the same situation except with better and more qualified people in our specialty.

Overall if we want to see net positive change, the total number of available slots must be slashed, a move that I don't foresee happening anytime soon. Barring funding issues which is rare, most programs really don't decrease the number of slots.

The only "good" I see coming out of this is that perhaps some of the governing bodies will take note and realize that the specialty is a sinking ship and they need to get their act together. Perhaps its wishful thinking, however, it was a very common talking point for years while the specialty was slowly eroding away that "we have more applicants than ever, EM is very competitive etc etc".

Not the case anymore. ACEP needs to get their heads out of the sand. The writing is on the wall.
 
Apollyon said:
Seriously, dude? They, totally, mean something. You can't just discount it like that.
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Yeah this take makes no sense. This is an unebelievable amount of unfilled spots. We all know most will fill with subpar candidates or FMGs/IMGs but it still sends a massive message.

Also, If a program fills most/all their spots with FMGs/IMGs that program is essentially DOA now. Permanent foreign program.

And it's appropriate. There's too many programs. Many programs need to be straight up shut down. People are just complacent with the recent job postings because they didn't hire during covid and stopped caring. There's still a 10k surplus. The study was done before covid.
 
RustedFox said:
Now... Eliminate any empty spot.
If any program filled zero spots, they're gone.
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Not EM, but 100% agree.

If a program can’t convince even a single person to rank to match the program is a complete dumpster fire. That’s incredible.

Think about how naive we all were applying to our fields/residencies? You didn’t really know what was important and were swayed by location, fellowship availability, and general “feel” of the program/attendings. Matching no one screams that a program completely failed everything; terrible location, terrible clinical experience, terrible feel. It couldn’t sway pie in the sky naive medical students with smoke & mirrors.

Close those programs. But not even just for supply/demand mismatch reasons, they clearly can’t provide a reasonable EM training experience, they obviously will graduate substandard physicians.
 
For a long time, EM paid well enough to compensate for it's known difficulties. Then, as pay dropped, gaslighting of recruits kept the specialty alive. Now, the pay and job availability have dropped below a threshold where even gaslighting of EM hopefuls is starting to buckle under weight of the specialty's problems. FMGs and mid-levels will tamponade the bleeding effectively enough for any meaningful change in the near future.

Until 1/3 of EM programs and attending jobs are unfilled, causing hospital system collapse, meaningful change isn't likely to occur. In fact, the powers that be may find FMGs fill the role better, in that their expectations are lower, in comparison to the health systems they're leaving behind.
 
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Robotic Wis-Hipple said:
Not EM, but 100% agree.

If a program can’t convince even a single person to rank to match the program is a complete dumpster fire. That’s incredible.

Think about how naive we all were applying to our fields/residencies? You didn’t really know what was important and were swayed by location, fellowship availability, and general “feel” of the program/attendings. Matching no one screams that a program completely failed everything; terrible location, terrible clinical experience, terrible feel. It couldn’t sway pie in the sky naive medical students with smoke & mirrors.

Close those programs. But not even just for supply/demand mismatch reasons, they clearly can’t provide a reasonable EM training experience, they obviously will graduate substandard physicians.
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Completely agree but this is wishful thinking. There is no body or group or anything with the ability to just go close these dump programs as far as I know. The RRC will take their money, make sure they checked the boxes in their application to meet their paltry minimum standards, and certify them. Abem has said they won't do anything as it's not their role. Acgme same. Who are the police?

Acep could make some kind of position to help but they won't. Why would they? Their corporate owners are incentivized to flood the em labor market and drive down their wage costs.

We are screwed unless a major shift happens and I honestly don't even know where it could come from.
 
EM will continue to fill unless pay drastically drops. Too many people love Gray's Anatomy, working 12 dys/mo, and not tied to a practice. Will be awhile but looks like saturation is slowing getting better.
 
It will be interesting to see what Friday brings. I'll admit ignorance of the details but I think people underestimate the barriers between an FMG and these positions and overestimate how eager the FMGs in a position to take these spots will be.
 
Birdstrike said:
For a long time, EM paid well enough to compensate for it's known difficulties. Then, as pay dropped, gaslighting of recruits kept the specialty alive. Now, the pay and job availability have dropped below a threshold where even gaslighting of EM hopefuls is starting to buckle under weight of the specialty's problems. FMGs and mid-levels will tamponade the bleeding effectively enough for any meaningful change in the near future.

Until 1/3 of EM programs and attending jobs are unfilled, causing hospital system collapse, meaningful change isn't likely to occur. In fact, the powers that be may find FMGs fill the role better, in that their expectations are lower, in comparison to the health systems they're leaving behind.
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The residencies might go unfilled but the attending jobs won’t. When there are 10k too many plus IM FM and NPs ready to work it won’t happen. I can see a shortage of residents as the EM “career” looks bleak and other options are available.
 
DeadCactus said:
It will be interesting to see what Friday brings. I'll admit ignorance of the details but I think people underestimate the barriers between an FMG and these positions and overestimate how eager the FMGs in a position to take these spots will be.
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No doubt. Would love to see how many spots remain unmatched. Some of the new programs will try to fill after the scramble as well.
 
gyngyn said:
Not at the moment (without a Match violation).
Someone could post something on Friday, I guess...
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this is one thing my profession actually does right - they release publically which programs have open spots before phase two
 
Dred Pirate said:
this is one thing my profession actually does right - they release publically which programs have open spots before phase two
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Seriously...not sure why this is supposed to be so secret. If you suck, future residents should have the right to know which one didn't match and figure out why programs didn't fill, whether it was clinical program, poor recruitment initiatives or just plain unlucky.

Though if you managed to match zero, you just very clearly plainly suck and need to shut down. How embarrassing is that!
 
JAFERD_MD said:
Seriously...not sure why this is supposed to be so secret. If you suck, future residents should have the right to know which one didn't match and figure out why programs didn't fill, whether it was clinical program, poor recruitment initiatives or just plain unlucky.

Though if you managed to match zero, you just very clearly plainly suck and need to shut down. How embarrassing is that!
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Because the NRMP cares more about making participating programs happy than it cares about current or future applicants. Most applicants only use their service once. Programs are regular customers.
 
RustedFox said:
Now... Eliminate any empty spot.
If any program filled zero spots, they're gone.
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Penn anesthesia filled zero spots in 1996. Now they’re thriving. Nothing lasts forever.

CDCECB26-064B-42BF-BDB8-749918C52981.jpeg
 
nimbus said:
Penn anesthesia filled zero spots in 1996. Now they’re thriving. Nothing lasts forever.

View attachment 351880
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Cool story, bro.
I bet if they did shut down, nothing would have changed.

Get a few dozen programs to shut down, because they're ass, and now you've made a statement.
 
Dr. Rude said:
Because the NRMP cares more about making participating programs happy than it cares about current or future applicants. Most applicants only use their service once. Programs are regular customers.
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Rhetorical question, but yes. Agree.
 
Dr. Rude said:
Because the NRMP cares more about making participating programs happy than it cares about current or future applicants. Most applicants only use their service once. Programs are regular customers.
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I wish I could disagree. Sadly, I cannot.
 
Rekt said:
Has anesthesia ever had an oversupply problem or too many residencies? The anesthesia/radiology "coming back from the dead" arguments don't work for EM.
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Yes….when I finished in 1996 there was an oversupply. Many practices would tell you how they were making money hand over fist at the interview, then offer you $110k. Every single one of my graduating cohort could not find a job in our training city and scattered throughout the country, many to BFE. Then about 7 years later after market conditions changed, 80%+ of my class returned to our city.
 
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EctopicFetus said:
The residencies might go unfilled but the attending jobs won’t. When there are 10k too many plus IM FM and NPs ready to work it won’t happen. I can see a shortage of residents as the EM “career” looks bleak and other options are available.
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I don't know many IM docs that want to work in the ED...
 
Splenda88 said:
Unfortunately, physician career is 30-yr long. No one wants to wait for 10+ yrs for their career to take off.
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Good chance things will be turned around by the time your training is done. It’s like buying low in the market when everbody else is selling. Those who matched anesthesia in 1996 (when the sky was purportedly falling) had very good timing. Based on the demographics of the USA, I think the future looks bright for every specialty and medicine is a good choice of career for young people.
 
nimbus said:
Good chance things will be turned around by the time your training is done. It’s like buying low in the market when everbody else is selling. Those who matched anesthesia in 1996 (when the sky was purportedly falling) had very good timing. Based on the demographics of the USA, I think the future looks bright for every specialty and medicine is a good choice of career for young people.
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Em included? Serious question. It’s a different animal imo. Medicine is not what it was.
 
Splenda88 said:
I don't know many IM docs that want to work in the ED...
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Family medicine? I know a bunch of I’m docs who want to work em or have. The younger crowd less so. The jobs available to them are fairly terrible now but they used to be able to get decent gigs.
 
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