555 EM spots did not fill in Match

[3rdJob]

So my middle daughter is a 3rd year medical student and obviously starting to consider residency and specialty choice. Very high EQ (MUCH higher than mine), and was considering FP, IM etc. Started her EM rotation, and LOVED it (Uh oh). Loved the procedures, and the acuity. Was seriously considering EM, and I STRONGLY encouraged her to talk to the graduating EM residents, and attendings about such a choice. Yup, she started getting a clue....

Nail in the coffin was the severe circadian disruption she experienced rotating from days-nights-etc.

I am delighted to annouce that she will be going into IM. That's a 'W.'

EM used to be good/great gig, and fortunately was for the majority of my career ( I might have 2-3 years left in me now). Not anymore folks. Not any more......

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Members don't see this ad.

 

[cyanide12345678]

So my middle daughter is a 3rd year medical student and obviously starting to consider residency and specialty choice. Very high EQ (MUCH higher than mine), and was considering FP, IM etc. Started her EM rotation, and LOVED it (Uh oh). Loved the procedures, and the acuity. Was seriously considering EM, and I STRONGLY encouraged her to talk to the graduating EM residents, and attendings about such a choice. Yup, she started getting a clue....

Nail in the coffin was the severe circadian disruption she experienced rotating from days-nights-etc.

I am delighted to annouce that she will be going into IM. That's a 'W.'

EM used to be good/great gig, and fortunately was for the majority of my career ( I might have 2-3 years left in me now). Not anymore folks. Not any more......

My children are never going into EM. Nope. Not allowed 🤣

I’m open to them going into medicine, but honestly id encourage my kids to do dental school, software engineering, or finance over medicine.

 

[Splenda88]

My children are never going into EM. Nope. Not allowed 🤣

I’m open to them going into medicine, but honestly id encourage my kids to do dental school, software engineering, or finance over medicine.

You should visit the dental forum. They think it's worse than medicine.

We just have to hope that things don't blow up in 5 yrs so most of us can be on the path to financial independence. Personally, I think it will take hospital medicine more than 5 year to be like what we are seeing happening to EM right now.

 

[bravotwozero]

You should visit the dental forum. They think it's worse than medicine.

A lot of truth there, debt to income ratio is pretty terrible for them graduating from dental school. White Coat Investor just did a blog post on that today.

 

[Splenda88]

A lot of truth there, debt to income ratio is pretty terrible for them graduating from dental school. White Coat Investor just did a blog post on that today.

It seems like no one is graduating dental school with a student debt < 450k unless you attend a public school or you got help from family.

The only thing that is going for them is that they start making money (150-200k/yr) sooner than physician.

 

[Rekt]

Let me add a few just for history sake.

CV surgeon I knew were literally taking cardiologist outs to take their scraps b/c they were cathing everything and nothing left for CV.
Rad Onc. Friend got in before it became hot, Banked, now bleak
Optho 20 yrs ago printed money and PP opening up surgical megasites. Now you rarely see many new sites.
Pain - From what I hear is being dragged down by reimbursement and competition
Cards - 15 yrs ago printing money, now I hear reimbursement has gone down. Lots of PP consolidation, being bought out, becoming essentially hospital employees.

If you think any high paying lucrative field will not have an oversupply issue you are mistaken. NO field has a large enough moat. If there is money to be had, there will be increased residency sites, NP infiltration, decreased reimbursement.

All specialty needs an exit plan. Again, swim faster than your colleagues.

We all know this.

In my opinion, the argument comes down to the fact EM is actually the hardest specialty in medicine. I won't broken record repeat the million reasons why this is true, but you might as well take the most comfortable seat while the plane falls from the sky.

 

[cyanide12345678]

It seems like no one is graduating dental school with a student debt < 450k unless you attend a public school or you got help from family.

The only thing that is going for them is that they start making money (150-200k/yr) sooner than physician.

450k+ debt. Ouch that’s terrible. Didn’t know dental school is this expensive. That’s just ridiculous.

 

[Splenda88]

450k+ debt. Ouch that’s terrible. Didn’t know dental school is this expensive. That’s just ridiculous.

Average tuition for 66 US dental schools

The University of the Pacific in Stockton, Calif., has the most expensive dental school in the U.S., with tuition at $119,360 per year, according to data from t

www.beckersdental.com

 

[Rekt]

Average tuition for 66 US dental schools

The University of the Pacific in Stockton, Calif., has the most expensive dental school in the U.S., with tuition at $119,360 per year, according to data from t

www.beckersdental.com

Stockton tuition at 119k per year. What in the actual ****? That is straight up criminal.

 

[Splenda88]

Stockton tuition at 119k per year. What in the actual ****? That is straight up criminal.

Another 22k for fees and supplies etc... plus housing, food and other bills.

DDS Tuition and Fees

University of the Pacific is a private institution with tuition and fees providing about two-thirds of the revenue necessary for the three-year doctoral program.

dental.pacific.edu

 

[emergentmd]

I hear USC is pushing 200+K when you add housing/living expense. Talk about close to 1M out the door. Dentist is 100x worse than EM.
Come out with 500K debt. You are essentially committed to working for someone or a "CMG" making less than 150K. If you are bold enough to open up your own practice, you are looking at around 500K in this higher interest environment is close to suicide as it takes atleast 1 year to get your scheduled full.

Optometry?

Pharmacy?

PT?


You best bet is PA or RN to NP if you are going to do medicine.

 

[miacomet]

I hear USC is pushing 200+K when you add housing/living expense. Talk about close to 1M out the door. Dentist is 100x worse than EM.
Come out with 500K debt. You are essentially committed to working for someone or a "CMG" making less than 150K. If you are bold enough to open up your own practice, you are looking at around 500K in this higher interest environment is close to suicide as it takes atleast 1 year to get your scheduled full.

Optometry?

Pharmacy?

PT?


You best bet is PA or RN to NP if you are going to do medicine.

RN is best- cheap two year degree, get your online BSN while you are working, then do psych NP and hang out your own shingle, or skip the online NP program and work at the VA, start accruing a pension at age 21, work your way up to max salary of 212k for a bedside RN and retire with a pension and great retiree bennies. Or skip out and do nonclinical work or informatics or whatever. Unparalleled flexibility, low debt, great earning potential, no liability, and society loves nurses.

 

[Ho0v-man]

RN is best- cheap two year degree, get your online BSN while you are working, then do psych NP and hang out your own shingle, or skip the online NP program and work at the VA, start accruing a pension at age 21, work your way up to max salary of 212k for a bedside RN and retire with a pension and great retiree bennies. Or skip out and do nonclinical work or informatics or whatever. Unparalleled flexibility, low debt, great earning potential, no liability, and society loves nurses.

CRNA is the best ROI in medicine by a landslide. If you’re geographically flexible, you make $300k+.

 

[GassYous]

CRNA is the best ROI in medicine by a landslide. If you’re geographically flexible, you make $300k+.

400+

 

[GonnaBeADoc2222]

400+

Hourly rate of total comp is the only thing that matters.

What's the highest you've seen for CRNA?

 

[Brigade4Radiant]

Honestly, if I had children, I would tell them to go into nursing do that for two years. Be in an academic hospital do the nursing residency that is available for new nurses.

After practicing as a nurse, for two years, do different things shadow doctors read medical residency text books and do questions

Be a nurse practitioner then do a residency in psych or do an endoscopy fellowship. Then you just walk off the dock see a bunch of people you can start your own practice and just hire an MD to sign your charts remotely. You don’t have any liability you have the flexibility and you have the decrease in that load because as a NP you can always work as a nurse.

With an MD you could potentially fail out a board exam and that limits you to a specialty like emergency medicine. Also US MD/DO medical school is competitive compared to NP and nursing programs.

You can just do community college and pay little to nothing.

You can also easily be an administrator

 

[Mbekweni]

Honestly, if I had children, I would tell them to go into nursing do that for two years. Be in an academic hospital do the nursing residency that is available for new nurses.

After practicing as a nurse, for two years, do different things shadow doctors read medical residency text books and do questions

Be a nurse practitioner then do a residency in psych or do an endoscopy fellowship. Then you just walk off the dock see a bunch of people you can start your own practice and just hire an MD to sign your charts remotely. You don’t have any liability you have the flexibility and you have the decrease in that load because as a NP you can always work as a nurse.

With an MD you could potentially fail out a board exam and that limits you to a specialty like emergency medicine. Also US MD/DO medical school is competitive compared to NP and nursing programs.

You can just do community college and pay little to nothing.

You can also easily be an administrator

Nursing school is also extremely competitive as the word is out. The community college programs that are next to free are a bloodsport trying to get in and I know people who take 3-5 years to get into the program even with good scores. That leaves the private programs where you come out with 100k or more in debt. Not insurmountable and about 1x income depending on where you practice but not the free lunch people are mentioning. Similarly, there is a state school PA program that's pretty good near me. They have over 1000 applicants for around 10 slots, just insane. Or you spend 150k or more on a private program and have similar debt struggles.

My wife did dental at USC, and with the ridiculous student loan burdens for them it pushed the graduating students in some not very surprising directions. A good portion went military to get their loans paid off. 4 years for 4 years and most actually liked it, some posts in rural bad areas, others like Camarillo, CA on the beach, Okinawa, Germany were pretty plush. Airforce if you can get in>>>navy/army. My wife just finished her 10 year PSLF after a long string of public health clinics. Some gratifying work in there but max salary of 150 (175k with benefits), but when you include the benefit of programs that pay your loans while working on an income driven repayment plan and then forgive the rest the effective comp becomes 250-400k in public health if it means your loans go away. I suspect the math could be similar for many physician specialties. I don't know any of her peers who were stupid enough to take out the 500k in loans and then take an associate job in a competitive area for 125k.

Student debt sucks and there is really no reason for schools to be this expensive.

 

[xaelia]

I think the better question is: what improves emergency medicine to the point it ought to be a desirable specialty? And how realistic are those changes?

Is it just getting a higher hourly rate for the same work?
Is it a quality of life issue where nights and weekends are reduced?
Is it a fundamental change in the culture of the staff and administrative support?
Is it a change in expected ratios of staff to patients so work is safe and sustainable?
Is it elimination of administrative/CMS/documentation overhead?
Is it elimination of defensive medicine considerations?
Is it a change in how other specialties use/treat the emergency department?
Is it a change in patient expectations and interactions with staff in the ED?
Is it elimination of midlevels?

These, and others, are the sorts of issues that define the median experience for most emergency medicine docs – and which of those are most important, and which can be realistically improved in the next 5 to 10 years?

 

[bravotwozero]

Laughable to think any of those can be changed. EPs don't have balls, and don't have power.

 

[GonnaBeADoc2222]

I think the better question is: what improves emergency medicine to the point it ought to be a desirable specialty? And how realistic are those changes?

Is it just getting a higher hourly rate for the same work?
Is it a quality of life issue where nights and weekends are reduced?
Is it a fundamental change in the culture of the staff and administrative support?
Is it a change in expected ratios of staff to patients so work is safe and sustainable?
Is it elimination of administrative/CMS/documentation overhead?
Is it elimination of defensive medicine considerations?
Is it a change in how other specialties use/treat the emergency department?
Is it a change in patient expectations and interactions with staff in the ED?
Is it elimination of midlevels?

These, and others, are the sorts of issues that define the median experience for most emergency medicine docs – and which of those are most important, and which can be realistically improved in the next 5 to 10 years?

#3, 8, 9 for me

 

[miacomet]

Honestly, I think the best thing to advocate for would be exit strategies in the form of useful fellowships that get people out of ER permanently- more sports med, occ med, palli, critical care, we need more.

We have fewer exit strategies than almost any other field. If we did, then the workforce issues would start to solve themselves as well all fled the field.

 

[FlaminHotER]

Pretty interesting quick read

Match Day 2023: Winners & Losers Edition

The envelopes have been opened. Fates – at least for the next 3-7 years – have been determined. Tears – hopefully of joy – have been shed. And just like that, another Match …

thesheriffofsodium.com

 

[heybrother]

https://www.washingtonpost.com/health/2023/03/17/match-day-emergency-medicine-doctor/

https://wapo.st/3TGJsxt (gift link)

Front page of the WaPo.

 

[miacomet]

Pretty interesting quick read

Match Day 2023: Winners & Losers Edition

The envelopes have been opened. Fates – at least for the next 3-7 years – have been determined. Tears – hopefully of joy – have been shed. And just like that, another Match …

thesheriffofsodium.com

"Still, the “just take the long view” argument seems a bit like climate change denialism to me. The downturn in applications from graduating U.S. MDs is precipitous and unprecedented. It is not inevitable that applicants will rebound. At the very least, the situation deserves a root cause analysis before glibly proclaiming that it’s just a blip."

 

[FlaminHotER]

"Still, the “just take the long view” argument seems a bit like climate change denialism to me. The downturn in applications from graduating U.S. MDs is precipitous and unprecedented. It is not inevitable that applicants will rebound. At the very least, the situation deserves a root cause analysis before glibly proclaiming that it’s just a blip."

How swiftly the tide turned in 2 years


Like @Birdstrike said, “best people in the worst system”

 

[Splenda88]

I predict the healthcare system as a whole will collapse within 10 yrs. EM is just only the first domino.

 

[miacomet]

I predict the healthcare system as a whole will collapse in 10 yrs. EM is just only the first domino.

I feel like it has collapsed, people just haven't noticed

 

[Splenda88]

I feel like it has collapsed, people just haven't noticed

I somewhat agree with you. The amount of waste in the system is incredible.

 

[WorkNoteEmergency]

I feel like it has collapsed, people just haven't noticed

Agree, I commented elsewhere that we are the canary in the coal mine. I see a huge amount of apathy and self preservation in the system with the lack of interest in the patient resulting in a flush to the ED. We’ve held the system together for now but not much longer.

 

[Dred Pirate]

Pharmacy?

nope- come over to the pharmacy forum and see the dumpster fire- used to be a very good return on investment - wages have stagnated in the past 10 years. I got lucky and got in when I in early 2000's. Number of schools were 84 when I started, now we are at 142. Now you need a 4 year undergrad, 4 year PharmD, at a minnimum of one year PGY-1 and many jobs require PGY-2 - so 10 years of college to make $125k as a new grad?

70% of grads end up working in the ****hole that is CVS or walgrees (or similar retail) - things might be turning as enrollment is actually going down - and people are struggling to find quality applicants (at least we are) but there are tons of unqualified applicants.

 

[Splenda88]

 

[Rekt]

I hate the news so much. How does anyone still watch this crap

 

[RustedFox]

That woman in the clip... "I want to make sure no medical errors are made like mine."

"I want to make sure that the people are treated like humans."

Lol.

 

[Splenda88]

That woman in the clip... "I want to make sure no medical errors are made like mine."

"I want to make sure that the people are treated like humans."

Lol.

She is not a physician yet.

 

[Moose A Moose]

The crazy thing is, is that they get government money.

Emergency medicine is now the specialty people don’t want we have a worse reputation than family medicine

With that hubris you deserve this reality check.

 

[RustedFox]

With that hubris you deserve this reality check.

Haven't seen you in awhile, amigo.

By "you", you mean "her", correct?

 

[GonnaBeADoc2222]

That woman in the clip... "I want to make sure no medical errors are made like mine."

"I want to make sure that the people are treated like humans."

Lol.

That optimism will be gone within 6 months of intern year.

 

[Ho0v-man]

That woman in the clip... "I want to make sure no medical errors are made like mine."

"I want to make sure that the people are treated like humans."

Lol.

I don’t how people go beyond third year of med school and still think like this. Like what were you doing the last 2 years of med school? At some point you must have talked to patients and started immediately abandoning hope, right? It was that just me?

 

[RustedFox]

That optimism will be gone within 6 months of intern year.

I don’t how people go beyond third year of med school and still think like this. Like what were you doing the last 2 years of med school? At some point you must have talked to patients and started immediately abandoning hope, right? It was that just me?

Like, most people in the ER behave like animals - not humans.

Typical nonsense feelgood story for the NPCs out there. "I had a surgical complication and I want to make SURE that medical ERRORS like this NEVER happen AGAIN to ANYONE else ZOMG !!11!!!!"

She'll be burned out halfway thru intern year.

Related: Mrs. Fox now works remotely doing clinical database management for Prestigious LeftCoast Hospital. Its has been 14 days. She has spent 13 of those 14 days doing "diversity, equity, and inclusion" training and memorizing weirdo's "pronouns". She's burned out already, because she was hired to "do the science and computing" and sees that: "Prestigious LeftCoast Hospital" is tripping all over themselves to not offend anyone that they don't care so much about the science.

 

[WilcoWorld]

That woman in the clip... "I want to make sure no medical errors are made like mine."

"I want to make sure that the people are treated like humans."

Lol.

The second one is totally reasonable, though I acknowledge that it is challenging at 2am.

The first one though, I hope Dr. Miller is able to accept its impossibility real fast. The ED eats perfectionists alive - I know from experience!

 

[EctopicFetus]

Property tax stinks for sure but its part of doing business. I have seen rates go up and not down given the current shortage.

I know of a place 1 hr from Austin that was paying 275/hr for years. Just got an email for $325/hr plus $75/hr when 3 month contract completed. Appears quite desperate and I am sure you can pick up as many shifts as you like. I believe they are 10 hrs. Suck it up, do 20 shifts would get you $240K in 3 months. I am sure there will be some bonuses too.

35% tax puts you at 156K. Live large on 56K, save 100K and invest S&P over 30 yrs would end up with about 1.5M historically. Seems simple but most docs don't do.

Explain this math.. save 100K and invest S&P over 30 yrs would end up with about 1.5M historically. Seems simple but most docs don't do.. 100k if you doubled every 7 years which would be about a 10% return gets you from 100k to 200k to 400k to 800k at year 28.. how do you get to 1.5M? I wouldn’t bank on this math. I think you can assume 9-11% returns but higher than that isnt coming from investing in SPY.

 

[Franzd'Epinay]

Explain this math.. save 100K and invest S&P over 30 yrs would end up with about 1.5M historically. Seems simple but most docs don't do..

I'm not sure what annual return the other poster is using, but I'll give it a go:

100,000 * (1.095)^30 = 1,522,031

100k if you doubled every 7 years which would be about a 10% return gets you from 100k to 200k to 400k to 800k at year 28.. how do you get to 1.5M? I wouldn’t bank on this math. I think you can assume 9-11% returns but higher than that isnt coming from investing in SPY.

Your way works too:

Year 0: $100k
Year 7: $200k
Year 14: $400k
Year 21: $800k
Year 28: $1.6m

 

[emergentmd]

Explain this math.. save 100K and invest S&P over 30 yrs would end up with about 1.5M historically. Seems simple but most docs don't do.. 100k if you doubled every 7 years which would be about a 10% return gets you from 100k to 200k to 400k to 800k at year 28.. how do you get to 1.5M? I wouldn’t bank on this math. I think you can assume 9-11% returns but higher than that isnt coming from investing in SPY.

S&P avg return 5 yrs 17%, 10 yrs 15%, 20 yrs 8.9%, 30 yrs 9.9%, 50 yrs 10.4%

For those 5 yr period, even considering the worse time frame of 8.9% puts you at 1.3M. Chose a comparable 30 yrs puts you at 1.7M. 50 yrs is 1.95M. So you actually have a better chance of being over 1.5M.

Most docs don't do this, you are right and I was one of them. It took me awhile to figure this out and I wish I did this earlier. I wish I could turn back time, tell my old self to save 300K and forget about it. I would have close to 5M in 10 yrs. I am just passing on alittle wisdom.

 

[sloh]

A FIRE number of 3-5 million may seem daunting at first but every physician, especially those who read this forum, should hustle and try to dump 1 million into index funds asap. It can be done within 5-10 years and after that, compounding really takes off. The first million is the hardest but it can be done with the right mentality, right work ethic, and just being reasonably smart with money.

 

[miacomet]

A FIRE number of 3-5 million may seem daunting at first but every physician, especially those who read this forum, should hustle and try to dump 1 million into index funds asap. It can be done within 5-10 years and after that, compounding really takes off. The first million is the hardest but it can be done with the right mentality, right work ethic, and just being reasonably smart with money.

Unless you don't have kids, or live in the South or Midwest, 3 million is pretty low for a decent standard of living. Really shoot for 5 million minimum, plus a paid off house, or other streams of income.

 

[stillwaiting]

Does anyone have a post SOAP list of spots currently open? Curious to see what is still out there. Thank you!

 

[EctopicFetus]

I'm not sure what annual return the other poster is using, but I'll give it a go:

100,000 * (1.095)^30 = 1,522,031



Your way works too:

Year 0: $100k
Year 7: $200k
Year 14: $400k
Year 21: $800k
Year 28: $1.6m

I started 7 years too late. My bad. But yes. All depends on the return you get for sure.

 

[HemorrhagicShock]

Consider how in 30 years 1.5m might have far less buying power than you think

 

[emergentmd]

CB

Consider how in 30 years 1.5m might have far less buying power than you think

30 yrs ago, a 1993 dollar is worth 2 dollars today. Assuming inflation is somewhat historical (yeah I know we are doing 6% now vs 3%), having 5M would be about 2.5M today. I think 10M in 30 yrs for a new grad retiring at 5M in today's purchase power would be the goal.

 

[avatarftw]

Similarly almost no one is amassing 1M net worth 5 yrs out of residency unless they have no loans, live in LCOL area, making 300/hr off the rip in a W2 setting where health insurance provided (or working spouse), saving aggressively.

It actually is very possible. I'm in a low paid clinical specialty and even with the stock market crash will be very close to the above situation you describe by dint of living very frugally during med school, residency, and as an attending spend about what the average family spends in the US. I've lived in high/very high COL areas after finishing residency but just save 50%+ of gross income.

I also was fortunate to participate in a very generous student loan program out of residency but graduated with the average med school debt.

If I made 350-450k like some other docs it'd be another story.

I do not have a family yet but also am a single income household and chose to live in a high COL area for family reasons and for other reasons.
A lot of people spend WAY more than what they need but my parents and grandparents were very poor growing up and passed along a scarcity mindset.