AAEM Position Statement on Growing # of EM Residency Programs

[BoardEligibleEventually]

AAEM is concerned with the rapid growth in the emergency medicine workforce, fueled by the accelerating growth in emergency medicine residencies, as well as the increasing number of advanced practice providers.

AAEM notes that the historic emergency physician shortage is rapidly resolving, and if current trends continue, an oversupply of emergency physicians is likely to develop, which may lead to negative consequences.

AAEM is concerned that in recent years, the vast majority of new emergency medicine residencies are sponsored by national contract management groups or by national hospital networks that may have a vested interest in creating an oversupply of emergency physicians.

AAEM urges all key stakeholders in emergency medicine to work with the ACGME Residency Review Committee to make changes to allow for balanced growth of the emergency physician workforce, with the goal to target the growth in the emergency physician supply to the projected growth in ED patient volume.

ORIGINAL LINK HERE

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[gamerEMdoc]

Good for them continuing to stand up to CMGs.

 

[Rekt]

AAEM is concerned with the rapid growth in the emergency medicine workforce, fueled by the accelerating growth in emergency medicine residencies, as well as the increasing number of advanced practice providers.

AAEM notes that the historic emergency physician shortage is rapidly resolving, and if current trends continue, an oversupply of emergency physicians is likely to develop, which may lead to negative consequences.

AAEM is concerned that in recent years, the vast majority of new emergency medicine residencies are sponsored by national contract management groups or by national hospital networks that may have a vested interest in creating an oversupply of emergency physicians.

AAEM urges all key stakeholders in emergency medicine to work with the ACGME Residency Review Committee to make changes to allow for balanced growth of the emergency physician workforce, with the goal to target the growth in the emergency physician supply to the projected growth in ED patient volume.

ORIGINAL LINK HERE

Was very happy to see this finally acknowledged. This paired with their stance on mid-levels. Hopefully they gain plenty of support. I know where I'll be putting my money eventually.

 

[InternistDO]

I don't say this to be negative, just out of genuine curiosity.

But what does this statement actually do, concretely? Obviously it's good that this potentially concerning issue is being addressed by one of the larger EM associations, but is this something the ACGME RRC will even listen to or consider?

 

[GonnaBeADoc2222]

I don't say this to be negative, just out of genuine curiosity.

But what does this statement actually do, concretely? Obviously it's good that this potentially concerning issue is being addressed by one of the larger EM associations, but is this something the ACGME RRC will even listen to or consider?

Nothing

 

[citymd1234]

This is cute

 

[emergentmd]

Glad I am within 10 yrs of retirement. Once there is an oversupply, rates for new grads will go down

 

[Restart13]

I agree with the statement. I think the demand problem is probably more a distributive problem. Not to mention, shops with residents let older docs stay on for longer, decreasing hours for new people coming up. That being said, I think EM is semi-generational? In my region I think there will be a turnover of docs retiring in the coming years as a significant portion retire.

 

[EM Junkie]

Glad I am within 10 yrs of retirement. Once there is an oversupply, rates for new grads will go down

Rates for everyone will go down.

 

[deleted497653]

About time they realized there is going to be an oversupply and I agree with above assessment that some of the problem is distribution.

 

[Rekt]

Nothing

This is cute

This is why it does nothing. You all have yours. For now.

 

[GonnaBeADoc2222]

This is why it does nothing. You all have yours. For now.

Confused what this is supposed to mean

 

[Groove]

I wonder if we will soak up the "undesirables", meaning gigs that traditionally have been staffed by IM/FM peeps out in nowherville. I can imagine a future where if salaries continued to go down but you could maintain higher pay in one of these smaller cities, it might start to look more attractive for the ABEM folks. So, I wonder if given that scenario, we would push out IM/FM before seeing our salaries drop or would boards not really matter in some of these places...

 

[Hercules]

I wonder if we will soak up the "undesirables", meaning gigs that traditionally have been staffed by IM/FM peeps out in nowherville. I can imagine a future where if salaries continued to go down but you could maintain higher pay in one of these smaller cities, it might start to look more attractive for the ABEM folks. So, I wonder if given that scenario, we would push out IM/FM before seeing our salaries drop or would boards not really matter in some of these places...

Boards would likely continue to not matter in those places. Especially if the contracts are still held by CMGs.

 

[GeneralVeers]

This is not really an issue for AAEM or ACEP. Regardless of their positions, HCA and the CMGs will continue to make more residencies if they think it helps them reduce their personnel costs.

The real culprits are ACGME and CORD. Why aren't these two organizations putting a stop to it?

 

[Brigade4Radiant]

It means join AAEM they are asking for support so they can call out residency expansion.

Also ED docs do this to themselves as they train new residents at the facility. Just do your job and don’t teach.

It’s easier than the worthless suggestion of not working for the CMG.

 

[tamman55699]

Which programs are you referring to? Which ones are CMG associated?

 

[miacomet]

Toothless, but well meaning, statement. ACEP has all the power and is owned by CMGs, so they won't put a stop to this.

Personally, I think EM is not the way to go for med students, but to each his own. That having been said, it's simply not worth it to me to work like we do for any less than we earn currently. Why would anyone deal with the stress of EM, the horrible shifts, and the general chaos and lack of respect, for less than $200 an hour minimum? I would hope people would jump ship at that point.

 

[BoardEligibleEventually]

This is not really an issue for AAEM or ACEP. Regardless of their positions, HCA and the CMGs will continue to make more residencies if they think it helps them reduce their personnel costs.

The real culprits are ACGME and CORD. Why aren't these two organizations putting a stop to it?

CORD is a joke. Nothing more than a coven of self-aggrandizing academicians placing their specialty and "the mission of education" on a f**** pedestal.

 

[hundreddaysoff]

CORD is a joke. Nothing more than a coven of self-aggrandizing academicians placing their specialty and "the mission of education" on a f**** pedestal.

"It is difficult to get a man to understand something, when his salary depends upon his not understanding it!"

 

[Rekt]

Is a critical care fellowship a reliable escape from the decline of EM?

 

[citymd1234]

Is a critical care fellowship a reliable escape from the decline of EM?

No

 

[citymd1234]

Is a critical care fellowship a reliable escape from the decline of EM?

No. Nothing is reliable for doctors. As a dispensable cog in a wheel, the rug can be pulled from under you anytime, anywhere.

 

[FMtoEM]

CORD is a joke. Nothing more than a coven of self-aggrandizing academicians placing their specialty and "the mission of education" on a f**** pedestal.

Wow.

 

[deleted941485]

Hey at least one of your orgs is brining attn to this. Not the case over in Rad Onc world where collective denial is the norm.

 

[RustedFox]

Wow.

Our class used to have to take the CORD EM quizzes every month as an evaluation tool.
Our PD and company were upset at our scores.
We collectively said - "Have you actually read these questions? Here; you try taking them and see how YOU do."
They did.
The next month, we didn't take the CORD EM quizzes anymore.

 

[Birdstrike]

No signs of oversupply on the horizon.
Graying doctors, patients to fuel 122K physician shortage by 2032, AAMC warns

 

[Restart13]

No signs of oversupply on the horizon.
Graying doctors, patients to fuel 122K physician shortage by 2032, AAMC warns

That's good, but I think with EM being a younger specialty, our physicians are significantly younger when compared to other physicians. I would interpret this as less turnover than other specialties in the coming years. Age Of Physicians By Specialty

 

[AlmostAnMD]

Personally, I would prefer ~all~ residencies shut down, all of you leave/retire, and me and @Tenk are the only two doctors in the country that practice EM. People pay us a million dollars to fly to their ED and resuscitate patients and we supervise 75,000 MLP's by just signing charts

 

[VA Hopeful Dr]

That's good, but I think with EM being a younger specialty, our physicians are significantly younger when compared to other physicians. I would interpret this as less turnover than other specialties in the coming years. Age Of Physicians By Specialty

True, but y'all still benefit from the increasing population. Plus us PCP types are almost 50% over 55, so between growing population and the retirement of PCPs we'll have a worsening primary care problem than we do now. People without PCPs, or PCPs they can't get in to see... well, we all know where they end up.

Plus, we all saw what Medicaid expansion did to ED volume in Oregon.

 

[Birdstrike]

That's good, but I think with EM being a younger specialty, our physicians are significantly younger when compared to other physicians. I would interpret this as less turnover than other specialties in the coming years. Age Of Physicians By Specialty

EM has been around for over 40 years. The reason EM docs are young, is not because the specialty is young ( it's old enough for the first batch of EM docs to be well into their 70's, 80's and 90's) but it's because people burn out before they get old and quit before docs in other specialties do. This lowers the average age of practicing EM doctors. That will continue to keep the ED physician supply lower than you'd expect looking at trend lines for other specialties. The longer you are in EM, the less crowded it gets as you look around and tally who's still actually doing it. That's my opinion, anyways, for what it's worth. I do Pain now, and I definitely has sense I could do this as long as I need to. Do I want to be doing Pain when I'm 75?
No, but I have no doubt, that I could, if I stayed healthy enough to work. On the other hand, there's no way in hell I could do EM into my 70's. When I did EM full time, I struggled to convince myself I could do it past 55. That number started inching down, the longer I practiced it.

Pace x Acuity x Circadian Disruption(squared) = A Freight Train of Burnout Comin' Attcha 60 mph

 

[Tenk]

Personally, I would prefer ~all~ residencies shut down, all of you leave/retire, and me and @Tenk are the only two doctors in the country that practice EM. People pay us a million dollars to fly to their ED and resuscitate patients and we supervise 75,000 MLP's by just signing charts

You forgot the part about playing contra.

 

[AlmostAnMD]

Good point,let's have a few more docs. But not more than 10, otherwise our salary will drop below 8 figures

 

[sylvanthus]

Pretty sure there is nothing at this point that can be done about midlevels. I say give them full independent practice rights with no supervision and let them fend for themselves. None of our organizations are really doing much about the enroachment, were pretty much fuxxored and on our own. I see the AMA, MSSNY, etc etc writing ridiculous PC resolutions about LQBTQWTFBBQ and other social justice warrior nonsense, but doing absolutely nothing about the dumbing down of medicine.

 

[random122893]

True, but y'all still benefit from the increasing population. Plus us PCP types are almost 50% over 55, so between growing population and the retirement of PCPs we'll have a worsening primary care problem than we do now. People without PCPs, or PCPs they can't get in to see... well, we all know where they end up.

Plus, we all saw what Medicaid expansion did to ED volume in Oregon.

What happened to the ED volume in Oregon? Pardon my ignorance.

 

[martvubo]

What happened to the ED volume in Oregon? Pardon my ignorance.

Oregon Medicaid health experiment - Wikipedia

"Over an 18-month period following the lottery, Medicaid coverage increased emergency department use by 0.41 visits per person, a 40% increase. Researchers found increases across a range of different types of visits, including visits classified as preventable or primary care treatable, and across different subgroups"

 

[Boatswain2PA]

And there was no improvement in health measures...

 

[TooMuchResearch]

EM has been around for over 40 years. The reason EM docs are young, is not because the specialty is young ( it's old enough for the first batch of EM docs to be well into their 70's, 80's and 90's) but it's because people burn out before they get old and quit before docs in other specialties do. This lowers the average age of practicing EM doctors. That will continue to keep the ED physician supply lower than you'd expect looking at trend lines for other specialties. The longer you are in EM, the less crowded it gets as you look around and tally who's still actually doing it. That's my opinion, anyways, for what it's worth. I do Pain now, and I definitely has sense I could do this as long as I need to. Do I want to be doing Pain when I'm 75?
No, but I have no doubt, that I could, if I stayed healthy enough to work. On the other hand, there's no way in hell I could do EM into my 70's. When I did EM full time, I struggled to convince myself I could do it past 55. That number started inching down, the longer I practiced it.

Pace x Acuity x Circadian Disruption(squared) = A Freight Train of Burnout Comin' Attcha 60 mph

Oh man, I'm not sure I can do this until I'm 55. Maybe if I cut my shifts in half.

 

[miacomet]

Oh man, I'm not sure I can do this until I'm 55. Maybe if I cut my shifts in half.

What's your escape strategy?

 

[BoardEligibleEventually]

What's your escape strategy?

Become an Administrator!

 

[Booze Aldrin]

No signs of oversupply on the horizon.
Graying doctors, patients to fuel 122K physician shortage by 2032, AAMC warns

Surely you jest? AAMC warns of physician shortage, news at 11!

Look, the AAMC is literally in the business of churning out medical students, and those students need residency positions so the sausage factory doesn't get backed up and revenue projections don't fall. They're forever kvetching about the doctor shortage so as to agitate for residency expansion and thus a means through which to expand medical school enrollment and their own revenue. Taking any "projections" the AAMC makes at face value is like believing the nonsense noise the agribusiness and big tech lobbies make each year about how if we don't double the gazillion cheap immigrant workers we took in last year into 2 gazillion this year, we'll starve to death and our computers will explode. Different singer, same tune.

 

[miacomet]

I would advise anyone against med school. No vale la pena. Aim for the C-suite and an MBA instead.

 

[RustedFox]

Become an Administrator!

This better be sarcasm.

 

[Birdstrike]

Surely you jest? AAMC warns of physician shortage, news at 11!

Look, the AAMC is literally in the business of churning out medical students, and those students need residency positions so the sausage factory doesn't get backed up and revenue projections don't fall. They're forever kvetching about the doctor shortage so as to agitate for residency expansion and thus a means through which to expand medical school enrollment and their own revenue. Taking any "projections" the AAMC makes at face value is like believing the nonsense noise the agribusiness and big tech lobbies make each year about how if we don't double the gazillion cheap immigrant workers we took in last year into 2 gazillion this year, we'll starve to death and our computers will explode. Different singer, same tune.

Okay. You say this source is biased towards the physician shortage side and that their data is biased in that direction. Fine.

Show me more reliable data from the other side that supports a coming ED physician oversupply and plummet EP wages.

Again, I have no dog in this fight. ED wages don’t affect me anymore, so I think I view the subject with the least bias than I’ve ever had on the subject. But show me the data from the other side. Something more than just a feeling.

 

[GeneralVeers]

Again, I have no dog in this fight. ED wages don’t affect me anymore, so I think I view the subject with the least bias than I’ve ever had on the subject. But show me the data from the other side. Something more than just a feeling.

I think we should err on the side of keeping supply tight. I'd much rather have a big shortage so as to keep our salaries and demand high. Plus it annoys the CMGs which is an added bonus.

 

[TooMuchResearch]

What's your escape strategy?

Prayer?

No definite plan :/

 

[EM Junkie]

I think we should err on the side of keeping supply tight. I'd much rather have a big shortage so as to keep our salaries and demand high. Plus it annoys the CMGs which is an added bonus.

I’m with you, but this doesn’t make a very good public policy argument unfortunately...

 

[Rekt]

I’m with you, but this doesn’t make a very good public policy argument unfortunately...

It works just fine for derm.

 

[VA Hopeful Dr]

It works just fine for derm.

Nope

Diversifying the specialty can result in high quality access to dermatologic care | American Academy of Dermatology

Learn more about Diversifying the specialty can result in high quality access to dermatologic care at aad.org

www.aad.org

Dr. Callender: In order to expand the dermatology workforce, we need to increase the number of residency positions in dermatology.

 

[Rekt]

Nope

Diversifying the specialty can result in high quality access to dermatologic care | American Academy of Dermatology

Learn more about Diversifying the specialty can result in high quality access to dermatologic care at aad.org

www.aad.org

Dr. Callender: In order to expand the dermatology workforce, we need to increase the number of residency positions in dermatology.

I was talking about forced limitations on derm residencies keeping salaries high. If derm proliferated as much as EM it would be about as competitive as FM/psych. Very obviously expanding their residencies would increase access to care, but it would also cut salaries and lifestyle.