ACGME proposing changes to EM residency requirements

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BigRhinoGuy

BigRhinoGuy

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Hot off the press. Per an ACGME webinar tonight.

All programs must transition to 4 years beginning 2027. Must have annual volume of 3,000 per resident. Lots of other small changes and new requirements. Wonder if this is aimed at shutting down some of the newer subpar programs?

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Apollyon said:
I wonder if it is the extra year of low paid labor. Doing a 4 year, 20 years ago, was the "$250k mistake". However, I do hope that you are correct, and, the trash programs get, well, trashed!!
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HCA would LOVE another year of low-pay labor.
 
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Could be a "win win" – there are also other ACGME changes coming through requiring better benefits/work conditions for residents, so I suspect the EM curriculum will no longer be quite as amenable to cramming it into 3 years. Ensures better training – with the happy effect the programs using EM for cheap labor can't meet the requirements. We should flood the feedback with requests the criteria be as stringent as possible.

Selfishly, if I'm still here in Christchurch by then, there's a lot more time in a 4-year curriculum to have a 2-month elective in New Zealand like what Parkland does in Hawkes Bay. If we were a hospital in the U.S., we'd be in the top 10 busiest EDs in the country!
 
There will be additional requirements like a required toxicology rotation and increased patient volume standard if implemented. I think their main goal is to reduce residency expansion and potentially close subpar programs that cannot meet the new requirements. From what I understand somewhere around 30 current programs would be shuttered based on the new patient volume standard being proposed.

I think current attendings should be all for these changes. It does suck for EM interested applicants, however, although the bright side is that there at least appears to be a plan to help curb rampant residency expansion which should hopefully have a positive effect on your future career if you choose EM.
 
Would love to hear med students thoughts on this, if the extra year sways their passion away from procedures, seeing the undifferentiated and what not.
 
EMdoc254 said:
Isn’t this a good thing? Less people going into EM, especially bottom of the barrel applicants who just want a quick residency. That’ll help with keeping supply low. And better residency standards to close some programs and discourage future ones.
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I think it is. We are all jaded and biased because we hate HCA (in specific) and like earning money in general. But 4 years of training would put a bit of a downward pressure on EM demand among people just looking to match anywhere in any field and also would (assuming residencies arent total crap) put out at least a slightly more refined product. Perhaps give some extra time for useful electives. Maybe yank the training standards up a bit because I have to imagine in places that arent at the top of the pathology mountain you really do have people who flat out arent getting enough exposure to uncommon procedures.

A stupid thing I've realized is that while I've run into people who have done like 15+ thoracotomies in residency and 10+ perimortem c-sections, most people are 0/1 and 0. (I was 5 and 3. Sadly since going into attending hood that's risen to 6 and 5). But there are people who have limited number of crichs! I get more time at a ****ty place doesnt fix that, but more time at a good place but just without the right type of uncommon pathology might actually fix that for some people.

The bias here is I did 4 years in an atypical way by doing 1 year of TRI back when that was a thing followed by a 3 year EM program. so I dont think 4 years is unreasonable at all
 
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I can't help but feel that an additional year of residency would have done very little if anything for me, so I see "4 years" and think: "Laaame", but whatever.

If that's the price to pay to get rid of profligate CMG residency expansion, then good.
 
RustedFox said:
I can't help but feel that an additional year of residency would have done very little if anything for me, so I see "4 years" and think: "Laaame", but whatever.

If that's the price to pay to get rid of profligate CMG residency expansion, then good.
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I think if you look at the effort/reward it pushed a lot of people into EM. 3 years of Peds/IM/FP and you make under 300k.. 3 years of fairly straightforward EM with lower work hours and voila it is 350-380k.

I dont think the 4 years is needed educationally but I do think more learning to read plain films, toxicology and broader knowledge would be good. I am all for this to stop the expansion of these *****ic residencies. If my math is correct and a minimum of 3k patients and a minimum class of 6 per class x 4 years is minimum volume of 72k.. is my math off here? That would shutter more than 30 programs I imagine.

I do think it is a win for the EM workforce. That being said I cant wait to hear the whining from some programs saying they cant afford this and shuttering residencies would lead hospitals to cut services or have financial issues.. I say too bad..
 
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EctopicFetus said:
I think if you look at the effort/reward it pushed a lot of people into EM. 3 years of Peds/IM/FP and you make under 300k.. 3 years of fairly straightforward EM with lower work hours and voila it is 350-380k.

I dont think the 4 years is needed educationally but I do think more learning to read plain films, toxicology and broader knowledge would be good. I am all for this to stop the expansion of these *****ic residencies. If my math is correct and a minimum of 3k patients and a minimum class of 6 per class x 4 years is minimum volume of 72k.. is my math off here? That would shutter more than 30 programs I imagine.

I do think it is a win for the EM workforce. That being said I cant wait to hear the whining from some programs saying they cant afford this and shuttering residencies would lead hospitals to cut services or have financial issues.. I say too bad..
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Try as I might, I can't figure out which word you wanted to use here.
 
It will help us attendings but for a med students EM will be the least competitive specialty for quite some time why do EM when you can do IM or FM? Med/Peds is 4 years OBGYN with all the specialties is 4 years and add 1 more year and you are doing the competitive surgery specialties

Also for college students more reason to do NP/PA than spend 8 years and only being able to work in EM. CRNA's make the same as a lot of ED attendings
 
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RustedFox said:
I can't help but feel that an additional year of residency would have done very little if anything for me, so I see "4 years" and think: "Laaame", but whatever.

If that's the price to pay to get rid of profligate CMG residency expansion, then good.
Click to expand...

i waffle on whether 3 is better than 4. I went to a 4.

I felt at the end of 4 I was extremely well trained in the medical parts of EM, but we have only average trauma training and poor ortho, ophtho, and peds like most other places.
 
Brigade4Radiant said:
It will help us attendings but for a med students EM will be the least competitive specialty for quite some time why do EM when you can do IM or FM? Med/Peds is 4 years OBGYN with all the specialties is 4 years and add 1 more year and you are doing the competitive surgery specialties

Also for college students more reason to do NP/PA than spend 8 years and only being able to work in EM. CRNA's make the same as a lot of ED attendings
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Agreed. The main reason why EM is competitive is because it's the highest-paid 3-year residency. It's why there are so many non-traditional and 2nd-career folks in the field. Make it 4 years and the decision becomes questionable.
 
Prehealth1011 said:
Agreed. The main reason why EM is competitive is because it's the highest-paid 3-year residency. It's why there are so many non-traditional and 2nd-career folks in the field. Make it 4 years and the decision becomes questionable.
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People would be better off with Neuro/Psych Anesthesia or Rads. Hell a lot of rural EDs have FMs and IMs working them
 
I’m 100% for it. As crappy as four years is, we need much stricter requirements. I’d even say more volume than the suggested.

But I doubt this will pass. Going to be incredibly amounts of bitching and moaning. Even from some “big name” places because their ED volume is actually trash.
 
Rekt said:
I’m 100% for it. As crappy as four years is, we need much stricter requirements. I’d even say more volume than the suggested.

But I doubt this will pass. Going to be incredibly amounts of bitching and moaning. Even from some “big name” places because their ED volume is actually trash.
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And so is their training..
 
JacobMcCandles said:
Judging by some of the new residents coming out, going to 5 years may not be an awful idea…
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If 4 years becomes a requirement, the competitiveness of EM will sink even lower.

An extra year in residency isn't going to fix any of the issues for the field. It certainly won't make the quality of the applicants higher. There will still be IMGs and Carribean grads to fill the spots, I assure you.

I'm ok with the volume requirement though.
 
Emapp20177 said:
If 4 years becomes a requirement, the competitiveness of EM will sink even lower.

An extra year in residency isn't going to fix any of the issues for the field. It certainly won't make the quality of the applicants higher. There will still be IMGs and Carribean grads to fill the spots, I assure you.

I'm ok with the volume requirement though.
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I don’t know if this has been done in other specialties but can there be a volume requirement coupled with a timeframe. Seeing on avg X number of patients of certain complexity per year?
 
Sounds like a way to fix resident oversupply while making all the current stakeholders happy-ish. Residencies get a longer period of cheap, competent labor, applicant pool is now no longer completely skewed by training length/money issues, existing attendings face less future competition,groups have a higher chance that new attendings they hire have a more rounded skill set. The only people who won’t like it and have skin in the game have no power to change it. Win-win.
 
Emapp20177 said:
If 4 years becomes a requirement, the competitiveness of EM will sink even lower.

An extra year in residency isn't going to fix any of the issues for the field. It certainly won't make the quality of the applicants higher. There will still be IMGs and Carribean grads to fill the spots, I assure you.

I'm ok with the volume requirement though.
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This.

The field is sunk in terms of attracting competitive high quality applicants.

The reputational damage will take years if not decades to repair.

IMGs and Caribbean applicants will still flood to 4 year programs, when their only other option is some trash Pedi residency.

COVID was the golden opportunity to seize back control. Walk out if our working conditions and pay demands not met. Our wuss colleagues couldn't go 2 months without a paycheck however.
 
Arcan57 said:
Sounds like a way to fix resident oversupply while making all the current stakeholders happy-ish. Residencies get a longer period of cheap, competent labor, applicant pool is now no longer completely skewed by training length/money issues, existing attendings face less future competition,groups have a higher chance that new attendings they hire have a more rounded skill set. The only people who won’t like it and have skin in the game have no power to change it. Win-win.
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4 year graduates are not superior to 3 year graduates.

3 year graduates even pass the boards at a higher rate.

www.acepnow.com

How Long Should EM Residency Be? New Studies Shed Light - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
www.acepnow.com www.acepnow.com
 
Emapp20177 said:
4 year graduates are not superior to 3 year graduates.

3 year graduates even pass the boards at a higher rate.

www.acepnow.com

How Long Should EM Residency Be? New Studies Shed Light - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
www.acepnow.com www.acepnow.com
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Maybe smarter people go to 3 year programs…😉
 
Emapp20177 said:
4 year graduates are not superior to 3 year graduates.

3 year graduates even pass the boards at a higher rate.

www.acepnow.com

How Long Should EM Residency Be? New Studies Shed Light - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
www.acepnow.com www.acepnow.com
Click to expand...
Brand new 3yr grads are extremely competent at dealing with emergencies. Nobody is disputing that. They often graduate without corresponding competency in dealing with non emergent patients, dynamics of leading a team, etc. This gap leads them to have to learn those skills on the fly in a much less forgiving environment than that of their training.

A curriculum that better reflects the environment EM grads find themselves in is sorely needed (and is not universally provided by current 4 yr programs either). 3rd yr programs estimated it takes roughly 3 and a half years of training to hit the competency and training goals new attendings need to have. That feels about right to me.
 
Prehealth1011 said:
Would love to hear med students thoughts on this, if the extra year sways their passion away from procedures, seeing the undifferentiated and what not.
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My potential first choice EM program is a 4 year so this doesn’t necessarily change anything. However, no longer having 3 year programs makes the decision so much easier.
 
Emapp20177 said:
4 year graduates are not superior to 3 year graduates.

3 year graduates even pass the boards at a higher rate.

www.acepnow.com

How Long Should EM Residency Be? New Studies Shed Light - ACEP Now

ACEP Now offers real-time clinical news, news from the American College of Emergency Physicians, and news on practice trends and health care reform for the emergency medicine physician. ACEP Now is an official publication of the American College of Emergency Physicians.
www.acepnow.com www.acepnow.com
Click to expand...

I went to a "powerhouse" 4 year program.

We graduate many idiots.

There is no reason for EM training to be 4 years.
 
I agree that the thought process behind this is at least progress, but yeah, probably going about it the wrong way. Why is it so difficult to engineer a solution that keeps it at 3 years but still weeds out ineffective programs?
 
Arcan57 said:
Brand new 3yr grads are extremely competent at dealing with emergencies. Nobody is disputing that. They often graduate without corresponding competency in dealing with non emergent patients, dynamics of leading a team, etc. This gap leads them to have to learn those skills on the fly in a much less forgiving environment than that of their training.

A curriculum that better reflects the environment EM grads find themselves in is sorely needed (and is not universally provided by current 4 yr programs either). 3rd yr programs estimated it takes roughly 3 and a half years of training to hit the competency and training goals new attendings need to have. That feels about right to me.
Click to expand...
Ill say the pass rate of the boards is tanking..
 
Its all a proposal for now but from what I hear is that if a residency had 24 total and 8 per class it would move to 6/class keeping the total at 24. It would slow the dump into the field but for me it would be best if they cut some programs.

I think 3 years is enough but I am all for making it as hard and painful as possible. I say that only as someone who wants these people to succeed. succeed but we need fewer.
Board pass rates are dropping. residents are definitely not doing as well as a whole. I suspect when the current 2nd years take their boards they will do horribly bad.. This 2nd year class was that super weak match class.
 
DocEspana said:
I think it is. We are all jaded and biased because we hate HCA (in specific) and like earning money in general. But 4 years of training would put a bit of a downward pressure on EM demand among people just looking to match anywhere in any field and also would (assuming residencies arent total crap) put out at least a slightly more refined product. Perhaps give some extra time for useful electives. Maybe yank the training standards up a bit because I have to imagine in places that arent at the top of the pathology mountain you really do have people who flat out arent getting enough exposure to uncommon procedures.

A stupid thing I've realized is that while I've run into people who have done like 15+ thoracotomies in residency and 10+ perimortem c-sections, most people are 0/1 and 0. (I was 5 and 3. Sadly since going into attending hood that's risen to 6 and 5). But there are people who have limited number of crichs! I get more time at a ****ty place doesnt fix that, but more time at a good place but just without the right type of uncommon pathology might actually fix that for some people.

The bias here is I did 4 years in an atypical way by doing 1 year of TRI back when that was a thing followed by a 3 year EM program. so I dont think 4 years is unreasonable at all
Click to expand...
Dude where do you work that you’ve done six thoracotomies and five perimortem C-sections?!?
 
EMdoc254 said:
Isn’t this a good thing? Less people going into EM, especially bottom of the barrel applicants who just want a quick residency. That’ll help with keeping supply low. And better residency standards to close some programs and discourage future ones.
Click to expand...
I don't know that this would weed out bottom of the barrel applicants. It could potentially decrease quality applicants even more. Quality applicants may then choose anesthesia or other 4 or 5-year specialties if emergency medicine is four as well.
 
Brigade4Radiant said:
It will help us attendings but for a med students EM will be the least competitive specialty for quite some time why do EM when you can do IM or FM? Med/Peds is 4 years OBGYN with all the specialties is 4 years and add 1 more year and you are doing the competitive surgery specialties

Also for college students more reason to do NP/PA than spend 8 years and only being able to work in EM. CRNA's make the same as a lot of ED attendings
Click to expand...
Exactly. Why do physicians need to do another year of residency, yet NPs can work in the ED with 500 clinical hours...? Why would an intelligent person do EM???
 
BoardingDoc said:
I know only one person who has done more than 5 crics. This isn't a flex for him. I think he just sucks at intubating.
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One of the two sites my residency trains at has a real wild West philosophy to education and a LOT of head trauma (people jump off buildings a lot I guess). Almost on principle they ask us to crich most of those head/face traumas. I know I graduated with over 20 crichs, likely over 30 (I don't think over 40. That seems like too many). I know that plenty of them were definitely optional, but I assumed the educational decision was to always opt in. Always assumed that's a normal thing in residency to finish with 20-30 of them. Maybe we were more wild west than I thought.

I've even done a few as an attending because I got a reputation as the airway guy (not because of the crichs!) and if my partner taps me on the shoulder and says he can't get the airway and then I can't get it on my first try, I'm criching because there have probably been too many attempts already with my one extra.
 
trackrunner321 said:
Exactly. Why do physicians need to do another year of residency, yet NPs can work in the ED with 500 clinical hours...? Why would an intelligent person do EM???
Click to expand...

You’ll have to answer that for yourself buddy.

Personally I wanted to do an important job competently. NP isn’t the path to that.

I also make about 3 times as much as our mid levels. We generally don’t hire NPs either.
 
TrailRun said:
Dude where do you work that you’ve done six thoracotomies and five perimortem C-sections?!?
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Harlem Hospital Center and Metropolitan in Harlem/Spanish Harlem for residency.

Added another perimortem C-section *on my first day as an attending* in a community hospital (baby made it. Mother did not). And got one extra of each in West Virginia on a locums assignment in Huntington where the trauma acuity was off the wall.
 
EctopicFetus said:
Yeah let me know so I never work there.
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1000042578.jpg


The joke was that the window were all glass so you could clean the blood off with Windex.
 
DocEspana said:
And got one extra of each in West Virginia on a locums assignment in Huntington where the trauma acuity was off the wall.
Click to expand...
I'd believe it. I did my residency just down the road in Charleston. Started my PGY-2 year off with trauma surgery doing an ED thoracotomy. I believe there was only 1 peri-mortem c-section while I was a resident. We had crazy acuity at the CAMC hospitals
 
EctopicFetus said:
Its all a proposal for now but from what I hear is that if a residency had 24 total and 8 per class it would move to 6/class keeping the total at 24. It would slow the dump into the field but for me it would be best if they cut some programs.

I think 3 years is enough but I am all for making it as hard and painful as possible. I say that only as someone who wants these people to succeed. succeed but we need fewer.
Board pass rates are dropping. residents are definitely not doing as well as a whole. I suspect when the current 2nd years take their boards they will do horribly bad.. This 2nd year class was that super weak match class.
Click to expand...
I think you know this, but it's not the residency with eight people per class that is going to be targeted with this. They'll just adjust number per year to keep the totals the same. I was talking with my old director about it this morning asking about if this would require him to decrease from 12 to 9 per year (probably).

It's the places with the minimum allowed 6 per year already who can't go from 18 to 24 and still meet the volume per resident requirements and aren't allowed to divide those 6 into fewer per year.
 
CajunMedic said:
I'd believe it. I did my residency just down the road in Charleston. Started my PGY-2 year off with trauma surgery doing an ED thoracotomy. I believe there was only 1 peri-mortem c-section while I was a resident. We had crazy acuity at the CAMC hospitals
Click to expand...
Huntington has a funny thing where the private hospital and the "county academic" hospital take turns being the trauma Center and the stemi center so that on any given day they would go to different hospitals. Trauma days were always much more fun than stemi days
 
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