[2017-2018] Emergency Medicine Application Thread

[GonnaBeADoc2222]

Well, I didn’t match. Not even in SOAP. I had 8 ranks. It was statistically improbable that I wouldn’t match.

I was devastated because of how they made me think I was a shoe-in. I now get to figure out where I went wrong with vague comments and try again next year.


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Others like @gamerEMdoc can comment, but I would think 8 on the ROL gives you a decent, but not amazingly strong chance of matching in EM these days. Did you rank all your interviews? What were your stats?

It's amazing the psychological games that are played post-interview. My wife had programs send her actual Christmas cards. It's nuts and way out of hand.

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[theSmurfette]

Others like @gamerEMdoc can comment, but I would think 8 on the ROL gives you a decent, but not amazingly strong chance of matching in EM these days. Did you rank all your interviews? What were your stats?

It's amazing the psychological games that are played post-interview. My wife had programs send her actual Christmas cards. It's nuts and way out of hand.

Low 210’s/mid-220’s. Low but not outside the range of possible. Went on 8, ranked 8.

I think I had a bad SLOE from my only away.


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[slurpy15]

Smurfette, I wish you the best of luck and you sound awesome.

I think you need to sit with your home PD and discuss anything that might have led to a bad SLOE, and if any of these issues could also have contributed to your CS issues. Maybe they were both terrible luck, and I don't underestimate that very real possibility. But it's also possible that there is something you may be able to improve on to enhance your applications next year. Usually away rotations won't crush you- they just won't rank you themselves but will give you a tolerable letter. And it's unlikely that your SLOE was written by someone who based their knowledge on working one shift with you; generally the faculty member responsible for SLOEs solicits feedback from all the faculty who worked with you.

Did you rank your home program? What feedback do they have for you on the cycle? Have you contacted the away program and asked how you can improve? What has your school advised you to do?

 

[theSmurfette]

Smurfette, I wish you the best of luck and you sound awesome.

I think you need to sit with your home PD and discuss anything that might have led to a bad SLOE, and if any of these issues could also have contributed to your CS issues. Maybe they were both terrible luck, and I don't underestimate that very real possibility. But it's also possible that there is something you may be able to improve on to enhance your applications next year. Usually away rotations won't crush you- they just won't rank you themselves but will give you a tolerable letter. And it's unlikely that your SLOE was written by someone who based their knowledge on working one shift with you; generally the faculty member responsible for SLOEs solicits feedback from all the faculty who worked with you.

Did you rank your home program? What feedback do they have for you on the cycle? Have you contacted the away program and asked how you can improve? What has your school advised you to do?

Been in constant contact the last week with my home PD. They ranked me to match "in the middle" but apparently they filled high (per them, I have no way of knowing for sure).

Yes I ranked home. It was my #1. I don't think any of my invites were from extremely competitive places.

 

[doggydog]

Good ED docs are able to fake the touchy-feely stuff too. It doesn't take much time either.

 

[theSmurfette]

Good ED docs are able to fake the touchy-feely stuff too. It doesn't take much time either.

My only guess was that I didn't do something how they expected. I empathized and moved on, not harp on it for 30 seconds. Had a bunch of kids in their early 20's and don't know what to think of that. I also tend to be somewhat casual when I talk to patients. I'm just a country girl who got the privilege of becoming a doctor. I'm not better than them, just got lucky, so I talk to them like a friend. Maybe it'll end up biting me in the ass over time. Who knows?

I do use empathy with patients and I'm genuine about it. I just didn't go overboard the way First Aid talks. Maybe doing it for so long, they began to expect it a certain way and I didn't. I treated them the same way I treat everyone I see and it didn't work. I spent only 7-8 minutes in the room. I normally don't take written notes but I was nervous and kept messing up the timeline so they probably thought I just wasn't paying attention. I didn't do all the counseling -- CAGE questions on any alcohol usage, smoking cessation. There were lots of little things that I didn't do and I guess they just added up. Then others I've seen that didn't do big stuff, multiple times and still passed. It's so subjective.

I already retook it. I guess I'll pass this time. Failing CS and then not matching has made me very skittish about anything and everything.

 

[slurpy15]

I bet and I'm sorry. CS and SLOEs are not my favorite thing as I'm not great at playing the game, but sadly in this era of medicine it's something we all have to learn, more than the medicine itself, for better or worse. It is awful.

How did you pick your away rotation? Was it recommended by your school? Are/can you extend for a fifth year and do more away rotations? What does your PD think you should do? What does your dean think you should do?

 

[theSmurfette]

What does your PD think you should do? What does your dean think you should do?

They are supportive of my plan. They also recommend applying for a back-up. That will be family medicine or pediatrics. I wish someone would just tell it to me plain and simple and to quit being vague.

 

[slurpy15]

I think you have a great plan. You can always do PEM, and I think the job market is better.

 

[gamerEMdoc]

I think you have a great plan. You can always do PEM, and I think the job market is better.

I think her plan is well thought out. Peds to Peds EM isnt a bad backup plan, as long as you like Peds. Because its a long haul to finally get to a place where you still make less money than a general EM doc. And I didnt find Peds EM to be very similar to EM at all, the practice patterns are so different.

Not discouraging this as a backup mind you, but you really have to love Pediatrics if you go that route.

 

[slurpy15]

You make a good point- PEM seems to err on the side of not thinking kids are sick, and they consult for all traumas etc. But there is much less burnout in PEM than general, and you have the back up of just doing PEM as you get older, whereas us ED docs are kind of screwed in that respect.

 

[gamerEMdoc]

Yeah I mean Peds EM docs are usually happy. Probably because they see way less patients who arent usually that sick. Dont get me wrong, they get some SICK kids, but in my experience rotating at one of the best Peds EM hospitals in the country, most of the patients were kids with fevers, kids with NVD, asthma/bronchiolitis, and kids with minor injuries. When you see colds and are getting viral panels to work them up, or “touching base” with a childs geneticist when they come in for a rash, or calling ortho to re-place a wet splint.... you start to realize they just dont practice real world EM. It’s almost its own field, with some aspects similar to EM... but not really... but they are almost always happy and friendly and Im sure that has a lot to so with their lower patient burden and lower acquity and the fact that they dont really deal with agitated drunk people, drug seekers (for the most part), etc. Also, all Peds EM docs pretty much stay in Peds EM training programs, and in general academicians burn out at way lower rates.

 

[GonnaBeADoc2222]

The unfortunate facts of the matter are that below average USMLEs and a CS fail are huge red flags that signal possible if not probable difficulty with passage of the ABEM board exam and academic difficulties during residency, two issues which no PD wants to deal with.

I would not advise PEM as an alternative to EM. Completely different mindset. 6 years of training, first of all. They are pediatricians first and EM doctors like maybe 3rd or 4th. The majority of their practice is either clinic patients who should have stayed home and be given Tylenol for their sniffles or ridiculously complex genetic/metabolic whatever, with little middle ground in between. The fellows I used to work with would only see the "interesting patients" and received very little training in how to actually manage the flow of a department. Their procedural skills are far inferior to EM trained docs; in fact, at some major centers, the PICU team will actually respond to certain cases and completely take over the management of the patient.

I will agree they do seem to be happy and burn out less though.

OP I truly hope you find happiness. Rejection sucks and not being able to practice in the field you want is a terrible feeling. I think other doors will open though. Good luck.

 

[slurpy15]

The unfortunate facts of the matter are that below average USMLEs and a CS fail are huge red flags that signal possible if not probable difficulty with passage of the ABEM board exam and academic difficulties during residency, two issues which no PD wants to deal with.

I would not advise PEM as an alternative to EM. Completely different mindset. 6 years of training, first of all. They are pediatricians first and EM doctors like maybe 3rd or 4th. The majority of their practice is either clinic patients who should have stayed home and be given Tylenol for their sniffles or ridiculously complex genetic/metabolic whatever, with little middle ground in between. The fellows I used to work with would only see the "interesting patients" and received very little training in how to actually manage the flow of a department. Their procedural skills are far inferior to EM trained docs; in fact, at some major centers, the PICU team will actually respond to certain cases and completely take over the management of the patient.

I will agree they do seem to be happy and burn out less though.

OP I truly hope you find happiness. Rejection sucks and not being able to practice in the field you want is a terrible feeling. I think other doors will open though. Good luck.

Agreed. The PICU does everything in peds hospitals and the ED docs do very little and are capable of even less. Curious as to what will happen now that many PEMs are working in community shops. I, for one, do not want to bail them out when I'm busy with my own patients. But, they seem happy and it's easy. So maybe a decent second choice if Smurfette likes peds, which she appears to be considering.

 

[theSmurfette]

I think you have a great plan. You can always do PEM, and I think the job market is better.

I think her plan is well thought out. Peds to Peds EM isnt a bad backup plan, as long as you like Peds. Because its a long haul to finally get to a place where you still make less money than a general EM doc. And I didnt find Peds EM to be very similar to EM at all, the practice patterns are so different.

Not discouraging this as a backup mind you, but you really have to love Pediatrics if you go that route.

Agreed. The PICU does everything in peds hospitals and the ED docs do very little and are capable of even less. Curious as to what will happen now that many PEMs are working in community shops. I, for one, do not want to bail them out when I'm busy with my own patients. But, they seem happy and it's easy. So maybe a decent second choice if Smurfette likes peds, which she appears to be considering.

I actually do like peds. I seriously considered it for a while. And PEM has always been in the back of my mind. Though, being older, it was unlikely I would pursue it. The prospect of finishing the fellowship at 42-43 is the main detractor from a plan of PEM.

I will probably dual apply to family medicine and EM next year. I should have done it this year.

 

[alexalex]

I actually do like peds. I seriously considered it for a while. And PEM has always been in the back of my mind. Though, being older, it was unlikely I would pursue it. The prospect of finishing the fellowship at 42-43 is the main detractor from a plan of PEM.

I will probably dual apply to family medicine and EM next year. I should have done it this year but I incorrectly assumed that I was a shoe-in for my home program.

Sorry you are going through this. Your PD or advisors should have recommended you to dual apply. If CS fail was a known issue to programs that is also a red flag for programs. However the kiss of death is a bad sloe and that's the one thing you can fix in upcoming months. It is very easy to look at the chart and feel safe with 8 interviews assuming you are in that % of matching people, but you had multiple red flags and I'm sorry noone sat with you and talked it out with you. I'm sure you will come ok from this, and make sure to research your away rotation sites and to seek feedback multiple times during rotations.

 

[theSmurfette]

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[GonnaBeADoc2222]

I'm confused why you didn't try to SOAP into IM (prelim or cat)/FM/Peds/Surg prelim.

Your US AMG status would have given you a great shot at at least being employed in some kind of an intern year next year.

Reapplication to EM with unfixable factors (USMLE) and a year away from real clinical exposure will likely not be successful.

I would not do Peds. Every fellowship is 3 years. The compensation with or without a fellowship is terrible. PEM is not similar to EM for reasons explained above. Now, if you have a legitimate academic interest in PEM beyond clinical practice, that might be a reason to go into PEM. Lots of work going on with regards to sepsis, ultrasound, gun violence, etc.

IM to CCM might be a good path if you enjoy the more longitudinal care that happens in the ICU.

FM or IM hospitalist might be best path if your goal is to get out there and start making some money.

Sounds like you got some real bad guidance from your advisers. I don't think one mediocre SLOE would have tanked you unless they described some exceptionally poor pattern of performance or there was a major professionalism issue. I really think the issue was your USMLE scores.

United States Medical Licensing Examination | Performance Data

Your Step 1 and CK scores aside, this shows a 97% CS pass rate for first time US MD test takers. Something caused you to be in this unfortunate 3%. Not saying this is a perfect test, or a fair system, but an EM PD looking at a CS fail, with some kind of unfavorable clinical comment on a SLOE is likely going to pass on you.

 

[theSmurfette]

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[MelMcT2009]

For those needing to do ACLS, BLS, PALS on your own before starting, where are you doing it? I see a bunch of online courses but am not sure if these are even legit.

 

[JacobMcCandles]

I’ve also been out of the clinical environment since September so that doesn’t help. I’ve thought about trying to come into my ED to just get my groove back but I’m really not in the mood to answer questions or be talked about behind my back. I feel like it’ll be awkward too because they screwed me over and I think they know that.


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This isn't the attitude of someone that wants to match. Quite frankly, many of your posts of been centered on being a victim. First it was the young CS standardized patients. Then it was because the away rotation was "weird". Now you're saying your home program screwed you over. Maybe programs were able to look past less than average scores and a possible less than stellar SLOE on paper but when it came time for the in person interview, they weren't able to look past your attitude/personality. If you really want to change your chances, I'd start by looking in the mirror then I'd do everything humanly possible no matter how awkward or uncomfortable it might be.

 

[gamerEMdoc]

I will be applying EM & FM next cycle. I like rural medicine and never planned to do EM in a big city

If you were looking at rural programs, I wish we would have crossed paths on the interview trail. Maybe next year!

This isn't the attitude of someone that wants to match. Quite frankly, many of your posts of been centered on being a victim. First it was the young CS standardized patients. Then it was because the away rotation was "weird". Now you're saying your home program screwed you over. Maybe programs were able to look past less than average scores and a possible less than stellar SLOE on paper but when it came time for the in person interview, they weren't able to look past your attitude/personality. If you really want to change your chances, I'd start by looking in the mirror then I'd do everything humanly possible no matter how awkward or uncomfortable it might be.

I get the tough love thing, but this is a little harsh. She just found out she didnt match this week after her home program told her she was a shoe in to match there. So I think the feeling of being screwed over is justified. And Id imagine most students in her situation who thought they were matching somewhere and were lied to wouldnt be super excited about going back and rotating at the same place right after the match.

Dont get me wrong, Im a big believer in brutal honesty, I just think you arent seeing things from the perspective of someone who didnt match just a few days ago, who was allegedly lied to. It is probably reasonable to cut her some slack and let her grieve a bit about not matching.

 

[theSmurfette]

This isn't the attitude of someone that wants to match. Quite frankly, many of your posts of been centered on being a victim. First it was the young CS standardized patients. Then it was because the away rotation was "weird". Now you're saying your home program screwed you over. Maybe programs were able to look past less than average scores and a possible less than stellar SLOE on paper but when it came time for the in person interview, they weren't able to look past your attitude/personality. If you really want to change your chances, I'd start by looking in the mirror then I'd do everything humanly possible no matter how awkward or uncomfortable it might be.

Thank you for your opinion, I did not intend for it to come across that way. Those things were postulations and atypical from the way that I have read about them for the last 8-9 years. If you knew me, you would have a completely different opinion.

I am honest with myself. I didn't put my full effort into my app because I thought I was staying home. I knew what they were looking for and stopped there. Now I know I need to go further to compensate for my scores so that I can show them that I am capable of becoming an EM physician. It was a rough few days but now I'm pulling myself together and ready to start working on the deficiencies that are within my ability to change.

 

[JacobMcCandles]

If you were looking at rural programs, I wish we would have crossed paths on the interview trail. Maybe next year!



I get the tough love thing, but this is a little harsh. She just found out she didnt match this week after her home program told her she was a shoe in to match there. So I think the feeling of being screwed over is justified. And Id imagine most students in her situation who thought they were matching somewhere and were lied to wouldnt be super excited about going back and rotating at the same place right after the match.

Dont get me wrong, Im a big believer in brutal honesty, I just think you arent seeing things from the perspective of someone who didnt match just a few days ago, who was allegedly lied to. It is probably reasonable to cut her some slack and let her grieve a bit about not matching.

If her program told her that she was a shoe in to match and then subsequently ranked her where she wasn’t a shoe in, I’d argue a lack of brutal honesty helped get her in this predicament.

I’ve been rejected in various ways throughout life. I give myself a day to grieve and feel sorry for myself and then I’m back out on the grind.

PS: I’ve read your post for years and you do a great service for students. Thank you for taking the time (uncompensated!) to truly give back.

 

[SalemK]

If her program told her that she was a shoe in to match and then subsequently ranked her where she wasn’t a shoe in, I’d argue a lack of brutal honesty helped get her in this predicament.

I’ve been rejected in various ways throughout life. I give myself a day to grieve and feel sorry for myself and then I’m back out on the grind.

Not everyone is you.

Not matching is brutal. Finding out later that someone decided they would rather write potentially career-ending comments in a SLOE than sit you down and communicate with you like an adult is nearly incomprehensible. I'm honestly flabbergasted that this happens every year, but it does. As a clerkship director or other faculty member, isn't it your responsibility to have a talk with any student who isn't performing as you would like and 1. give them a chance to discuss the matter and 2. give them a chance to improve?

Everyone tells you that "everyone lies," including PDs, but don't you WANT to believe that these people you admire and respect are telling you the truth? Why is it acceptable for programs not only to be dishonest with students about their odds, but to flat-out lie to them? No one likes uncomfortable conversations, but isn't this the program's basic responsibility to their students -- to be honest?

I know a few folks who have failed CS/PE, and not one of them are bad docs or even socially awkward. None of them had ever failed a standardized patient exam.

Seems to me like she has already reflected and found areas on which to improve, because the question "Why didn't you match?" is going to come up many, many times in her future. It's not unreasonable to need some time to process through emotions of self-doubt and also feeling betrayed -- especially while your peers are celebrating and may not have played the game any differently. The AAMC actually recommends grief counselors be available for students who didn't match, although I'm not aware of anyone who provides this.

 

[SavaEm]

I ended up matching at my #2 choice in NYC (very happy) but I, too, wish my home program advisers were more honest about my competitiveness as an EM applicant. I didn't have any total deal breakers (220s/230s, CS pass, P/HP SLOEs) and had a few things that made me a more competitive applicant. But I was in bottom third of my class, borderline step scores, and my "Pass" SLOE was from my home institution- which I hear is a red flag for a lot of programs. I had no idea. I applied to 73 programs, most of them being mid-tier, and stuck mostly to the East Coast from Boston to DC. I only got 14 interview invites, and was very unimpressed by half of them. Went to all 14, and ranked all 14. I honestly was expecting interviews from place I heard nothing from. I was silently waitlisted at almost every NY program I thought would want to meet me, since I'm a native New Yorker. I was confused during the interview process and learned only from watching this thread that people who got the interviews I expected actually had a more competitive profile than I did. I don't know why my home program didn't clue me in.

 

[slurpy15]

I ended up matching at my #2 choice in NYC (very happy) but I, too, wish my home program advisers were more honest about my competitiveness as an EM applicant. I didn't have any total deal breakers (220s/230s, CS pass, P/HP SLOEs) and had a few things that made me a more competitive applicant. But I was in bottom third of my class, borderline step scores, and my "Pass" SLOE was from my home institution- which I hear is a red flag for a lot of programs. I had no idea. I applied to 73 programs, most of them being mid-tier, and stuck mostly to the East Coast from Boston to DC. I only got 14 interview invites, and was very unimpressed by half of them. Went to all 14, and ranked all 14. I honestly was expecting interviews from place I heard nothing from. I was silently waitlisted at almost every NY program I thought would want to meet me, since I'm a native New Yorker. I was confused during the interview process and learned only from watching this thread that people who got the interviews I expected actually had a more competitive profile than I did. I don't know why my home program didn't clue me in.

That's a nice ending to your story. I know a lot of PDs are really invested in the SLOE system, but to me it seems less than objective and rife with abuse. Agreed your home program should have been more supportive AND more honest, although it would have been a shame if that honesty had dissuaded you from pursuing EM. Hats off to anyone who can stand EM residency in NYC, and I hope there will be jobs for you when you are done!

 

[theSmurfette]

For those needing to do ACLS, BLS, PALS on your own before starting, where are you doing it? I see a bunch of online courses but am not sure if these are even legit.

I would check with your school. I know I can do them through our hospital at no cost. It’s how I did ACLS for my away.

I know you can do the class part through AHA online and only do a skills session in person.


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[GandalfTheWhite]

If you were looking at rural programs, I wish we would have crossed paths on the interview trail. Maybe next year!



I get the tough love thing, but this is a little harsh. She just found out she didnt match this week after her home program told her she was a shoe in to match there. So I think the feeling of being screwed over is justified. And Id imagine most students in her situation who thought they were matching somewhere and were lied to wouldnt be super excited about going back and rotating at the same place right after the match.

Dont get me wrong, Im a big believer in brutal honesty, I just think you arent seeing things from the perspective of someone who didnt match just a few days ago, who was allegedly lied to. It is probably reasonable to cut her some slack and let her grieve a bit about not matching.

This happened to me as well.

High 230s/230s, middle 1/3 SLOEs with what I was told were good comments, several research pubs. No red flags or professionalism issues, but I was in 4th quartile. Was told by my home program that they "expect me to rank them in my top 3" and that I was a very competitive applicant. Turns out not only didn't I not match, I failed to match at any program (15 interviews). I emailed most of the PD's whose email I had. One mentioned that I was less competitive due to a 4th (bottom) quartile. Another mentioned to get a new SLOE. Both of these things could have been advised to me by my home program. They wouldn't even tell me if my SLOEs were competitive or had a red flag in them, which I think is a disservice, especially since many other PDs across the nation do it to help their students. And they recommended that I NOT apply to backup programs or specialties. And no, I'm not an awkward interviewer. Thankfully, I found an outside PD who is now properly advising me, and I am really thankful to have someone be honest with me going forward.

Its just a ****ty process that cost me 1 year of an attending's salary. I really hope CORD fixes this issue of how some students fall through the cracks and helps out the students who truly want to be EM docs.

 

[gamerEMdoc]

If her program told her that she was a shoe in to match and then subsequently ranked her where she wasn’t a shoe in, I’d argue a lack of brutal honesty helped get her in this predicament.

I’ve been rejected in various ways throughout life. I give myself a day to grieve and feel sorry for myself and then I’m back out on the grind.

PS: I’ve read your post for years and you do a great service for students. Thank you for taking the time (uncompensated!) to truly give back.

I know. I know that to you being brutally honest was actually your way of trying to help. I could see that in your post, you were just trying to help, by being as brutally honest as possible. I don’t want it to come accross like I was attacking you, I wasn’t. Its just, not everyone takes something like this that well. Everyone’s situation is different. It’s only been a few days. She will have plenty of time to take a hard look at her app and within herself to determine how to be better, it just seemed like it was too early for the tough feedback.

Not everyone is you.

Not matching is brutal. Finding out later that someone decided they would rather write potentially career-ending comments in a SLOE than sit you down and communicate with you like an adult is nearly incomprehensible. I'm honestly flabbergasted that this happens every year, but it does. As a clerkship director or other faculty member, isn't it your responsibility to have a talk with any student who isn't performing as you would like and 1. give them a chance to discuss the matter and 2. give them a chance to improve?

Everyone tells you that "everyone lies," including PDs, but don't you WANT to believe that these people you admire and respect are telling you the truth? Why is it acceptable for programs not only to be dishonest with students about their odds, but to flat-out lie to them? No one likes uncomfortable conversations, but isn't this the program's basic responsibility to their students -- to be honest?

I know a few folks who have failed CS/PE, and not one of them are bad docs or even socially awkward. None of them had ever failed a standardized patient exam.

Seems to me like she has already reflected and found areas on which to improve, because the question "Why didn't you match?" is going to come up many, many times in her future. It's not unreasonable to need some time to process through emotions of self-doubt and also feeling betrayed -- especially while your peers are celebrating and may not have played the game any differently. The AAMC actually recommends grief counselors be available for students who didn't match, although I'm not aware of anyone who provides this.

Well said.

 

[gamerEMdoc]

Thankfully, I found an outside PD who is now properly advising me

Must be a saint

 

[slurpy15]

I

I know. I know that to you being brutally honest was actually your way of trying to help. I could see that in your post, you were just trying to help, by being as brutally honest as possible. I don’t want it to come accross like I was attacking you, I wasn’t. Its just, not everyone takes something like this that well. Everyone’s situation is different. It’s only been a few days. She will have plenty of time to take a hard look at her app and within herself to determine how to be better, it just seemed like it was too early for the tough feedback.



Well said.

You must be a lovely program director! Very kind.

 

[gamerEMdoc]

I



You must be a lovely program director! Very kind.

I mean, APD. But I’d take the promotion.

Actually in real life, I’m pretty bitterly sarcastic about most things. But I do deeply care about medical education, residency admin, and mentorship.

 

[slurpy15]

In all honesty, do you think EM is a good field for students these days? I don't know where you work or what kind of program, but with the encroachment of corporate/employed jobs and the explosion of midlevel staffing, are you really optimistic about the future of EM for younger docs?

 

[gamerEMdoc]

I still do. Believe me, I do believe there are threats to our field. CMGs slowly taking over. The explosion of midlevels. Whatever payment system we gravitate too as a nation. But still, in the end, I’m optimistic. There are entire ED’s out there that are staffed without a single board certified ED doc. Many of them. I don’t believe, at all, that we are going to be threatened by having too many ED docs, at least not anytime soon.

And if that ever happens, and we do see a swing back in the supply/demand pendulum, then EM will lose popularity, less people will go into it, and the cycle will start anew.

 

[slurpy15]

I still do. Believe me, I do believe there are threats to our field. CMGs slowly taking over. The explosion of midlevels. But still, in the end, I’m optimistic. There are entire ED’s out there that are staffed without a single board certified ED doc. Many of them. I don’t believe, at all, that we are going to be threatened by having too many ED docs, at least not anytime soon.

And if that ever happens, and we do see a swing back in the supply/demand pendulum, then EM will lose popularity, less people will go into it, and the cycle will start anew.

Good points. How about midlevels, PG, and the ultimate takeover by CMGs?

 

[gamerEMdoc]

Well, CMGs are taking over because we are letting them. Without the Docs that sign with them, they don’t exist. So in a way, the CMGs only have as much power as we give them. If they pay well enough, docs will agree to be employed by them. If they don’t, then docs won’t sign with them. I think they are a threat to private groups that really rake in high salary jobs, but for the most part, I’m not sure they are a huge threat to most of us in terms of a salary difference. If USACS took over my job right now, I doubt my salary would change much.

I don’t know about midlevels. I really don’t see them as a big threat, but that’s just a gut feeling on my part.

 

[slurpy15]

I hope residency folk such as yourself explain that there is never a reason to sign with a CMG! Locums is always a better option. Nothing more satisfying than making a CMG pay a locums company to pay you. Heheh.

BUT- they make life rough for ALL of us by promoting hiring midlevels and decreasing physician staffing and also by devaluing EM as a field and hiring FPs. They even have an FP "residency." Now they have their own residencies, which is hugely concerning. We shall see...hopefully there will be FSEDs and perhaps hospitals will realize CMGs aren't giving them good service.

 

[gamerEMdoc]

Yeah, the CMG thing, I’m not crazy about obviously. But some of my residents go work in geographic areas where they don’t have a choice honestly. There’s segments of the country completely dominated by CMGs. But yeah, no doubt, locums is a sweet gig. If anything, I think locums docs might be the most threatened by the rise in the number of EM trainees and the CMG takeover.

 

[slurpy15]

That's interesting. My theory is that many new grads (you might have a better take on this) are super psyched about doing locums and working part time, and it seems that since no one wants to work for a CMG, they are highly dependent on locums. I have thought for a long time that locums would actually be the future of hte field- CMGs pay poorly and treat people worse, so my though was people would elect locums as their loyalty is not rewarded. It seems like places with CMGs need MORE locums because docs are unhappy, whereas SDGs NEVER do.

I agree we all need something nonclinical, but that can be very hard to find, and even harder to get paid for.

 

[gamerEMdoc]

That's interesting. My theory is that many new grads (you might have a better take on this) are super psyched about doing locums and working part time, and it seems that since no one wants to work for a CMG, they are highly dependent on locums. I have thought for a long time that locums would actually be the future of hte field- CMGs pay poorly and treat people worse, so my though was people would elect locums as their loyalty is not rewarded. It seems like places with CMGs need MORE locums because docs are unhappy, whereas SDGs NEVER do.

I agree we all need something nonclinical, but that can be very hard to find, and even harder to get paid for.

I think the reason CMGs need locums is they over promise. They can come in and take a hospital’s EM contract even if they don’t have the numbers of docs to actually staff that ED. It’s absurd.

 

[slurpy15]

Agreed. And this is why I think/hope locums will continue. That and no one wants to live in Texarkana. If you look at the UK, EM is all locums because docs have realized there is no reason to be employed.

 

[theSmurfette]

That and no one wants to live in Texarkana.

Hey, I resent that! I'd live in Texarkana. Well, in the vicinity, city living is not for me. Never heard the greatest things about St. Michaels (or Wadley) though.

 

[Apollyon]

Hey, I resent that! I'd live in Texarkana.

Yeah, but I hear that Rosanna is pretty tough with a broom!

 

[WernickeDO]

Hey, I resent that! I'd live in Texarkana.

I hear the mud soup and charcoal arugula are outrageous there.

 

[slurpy15]

Well, I didn’t match. Not even in SOAP. I had 8 ranks. It was statistically improbable that I wouldn’t match.

I was devastated because of how they made me think I was a shoe-in. I now get to figure out where I went wrong with vague comments and try again next year.


Sent from my iPhone using Tapatalk

Would this help you? They have a bunch of spots. It is HCA...https://i.redd.it/py3ncok5cxm01.jpg

 

[theSmurfette]

Would this help you? They have a bunch of spots. It is HCA...https://i.redd.it/py3ncok5cxm01.jpg

Thanks! I know it’s HCA but not trying is a $250k+ decision.


Sent from my iPhone using Tapatalk

 

[theSmurfette]

Double post

 

[enalli]

Didn't CMGs take over on the physician side because of exploitative practices by SDGs? Why would a new grad sign for peanuts at an SDG ("sweat equity") for a partner position that may never exist over signing for a steady paycheck with a CMG?

Is this a huge mischaracterization of what happened?

 

[engineeredout]

I hear the mud soup and charcoal arugula are outrageous there.

But I see they've obmitted the pork loin with lime jello.