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I specifically applied to exactly zero four year programs.
Same .
I specifically applied to exactly zero four year programs.
That's great... But that is not universal. Midlevels seeing high acuity patients with no real time supervision is super common, so it's actually a very valid comparison when considering EM as a whole... Not just where you happen to work.I don’t think comparing to midlevels is an accurate comparison. At least in our EDs, midlevels and physicians function in different capacities with oversight of the midlevels.
Same. 4 year programs were a hard no for me.I specifically applied to exactly zero four year programs.
Is it super common? I don’t know of any hospitals in my region with midlevels seeing high acuity patients. I guess if it’s single physician coverage and there’s multiple critical patients they’ll help out until the physician takes over or under close supervision.That's great... But that is not universal. Midlevels seeing high acuity patients with no real time supervision is super common, so it's actually a very valid comparison when considering EM as a whole... Not just where you happen to work.
I think it's location dependent... At the moment. Most states now allow NPs full independent practice. Their use in the ED is expanding, not contracting, not stagnant.Is it super common? I don’t know of any hospitals in my region with midlevels seeing high acuity patients. I guess if it’s single physician coverage and there’s multiple critical patients they’ll help out until the physician takes over or under close supervision.
There was just a study published that something like 7% of all EDs in the US are staffed with noctors only. I didnt read the paper but im sure most of those are CAH/low volume sites but still sick people will show up there. I live in a heavy HCA market. The noctors there are working equal to an MD. At another local site they staff 1 doc and 3 MLPs at a time.. I work at none of these places but this is the local market..Is it super common? I don’t know of any hospitals in my region with midlevels seeing high acuity patients. I guess if it’s single physician coverage and there’s multiple critical patients they’ll help out until the physician takes over or under close supervision.
There was just a study published that something like 7% of all EDs in the US are staffed with noctors only. I didnt read the paper but im sure most of those are CAH/low volume sites but still sick people will show up there. I live in a heavy HCA market. The noctors there are working equal to an MD. At another local site they staff 1 doc and 3 MLPs at a time.. I work at none of these places but this is the local market..
So I would agree that it is fairly common that the MLPs work as Physician equivalents yet are beyond dumb and incompetent.
When I see AZ, I think of: age 15, someone can open carry a firearm, and, no matter your age, as long as you're over 18, you can get a driver license valid until you're 65.Aren't you in AZ?
i was.. now somewhere else..Aren't you in AZ?
Because, no matter where you go....i was.. now somewhere else..
I think “needing” 4 years is a joke.. that being said I am of the opinion that ANYTHING that makes it harder for programs to survive is a positive. I trained at a 3 year program and throughout my career have always had stellar reviews and nurses always ask me to see their kids and families which i view as them thinking i have decent skills.ACGME can't just close programs. The only way is to increase requirements. They did that, and working backwards from their new requirements they showed that they only fit in a 4 year model. Some programs will shutter because of this, and at the very least, it makes it more onerous for fly by night programs to pop up. Is this the same as ACGME giving each EM attending 5 million dollars and a pony? No... but after years of dooming about how this specialty is dead, it seems like a step in the right direction. As for NPs, I'd argue that it would be extremely hypocritical for anyone to advocate for hiring NPs or replacing docs with NPs while advocating for 4 years, however 99% of us are in no position to change NP hiring, oppose it, and can still recognize this is a positive for the job outlook. "The test of a first rate intelligence is the ability to hold two opposing ideas at the same time and still retain the ability to function."
Im ok with pulling up the ladder behind me. Ironically, if this goes through the only people graduating in 2030 would be the ones from 4 year programs.
Leadership that wants to protect themselves.It's not pulling up the ladder. **** programs have proliferated... this is a response largely to that.
This is probably what Rad Onc should have done 10 years ago. I'm actually super pleased that there's still leadership with the balls to make a big change in our field.
Leadership that wants to protect themselves.
The people who made these recs are nearly uniformly from 4 year programs.. as EM gets less competitive the quality of doc who is willing to make the 250k mistake drops quickly especially if they are smart enough to understand the workforce issues. The move is therefore to make everyone like you to keep things as is for yourself and stress others thereby making your program more desirable.How so?
The problem is all the caveats and nonsense sim and the million ways to get around the requirements.My humble opinion is that ACGME should set expectations for the number of ED patients a person sees in residency, the required non-EM rotations that need to be done, and then leave it up to the programs to determine how to get this done.
If you're at big, busy program and you work 50-60 hours per week getting patients seen, then maybe you should be able to get that done in 3 years. If you're at a smaller, slower site relative to the number of residents and you schedule your residents closer to 40 hours per week, then you need to take 4 years.
This is of course besides the other requirements such as procedural logs (necessitating training someplace with adequate pathology).
Extremely uncharitable interpretation of their motivations. Can’t say you’re wrong, but doubt this is much of what’s driving the changes.The people who made these recs are nearly uniformly from 4 year programs.. as EM gets less competitive the quality of doc who is willing to make the 250k mistake drops quickly especially if they are smart enough to understand the workforce issues. The move is therefore to make everyone like you to keep things as is for yourself and stress others thereby making your program more desirable.
I find most of the ACEP / Ivory tower crew very uncharitable. Whats driving the change is the fear of the workforce collapse. This would be a death knell to most ivory tower gigs.Extremely uncharitable interpretation of their motivations. Can’t say you’re wrong, but doubt this is much of what’s driving the changes.
So what are the chances this actually passes, all programs become 4 years, and no medical student applies to EM anymore?
ThisHonestly I think the notion that "nobody will apply EM" is absurdly hyperbolic.
If a global pandemic, a jobs report predicting a cataclysmic labour market in 10 years' time, record high burnout rates and nearly daily feedback from current residents and practicing attendings that the actual practice of emergency medicine sucks @ss couldn't discourage >1500 lemmings from applying EM annually...
...why do we suddenly think that a transition from predominantly 3 years to all 4 year residencies will be the nail in the coffin?
Particularly when you consider that all AOA programs were 4 years before the merger, and 4 year programmes in places like New Haven, CT, Providence, RI, Rochester, the Bronx and fxcking Newark NJ fill on a regular basis despite being in 3rd tier cities in the freezing northeast, I don't think this is going to suddenly make med students consider doing IM or another specialty.
The open spots last year oppose your absurdity.Honestly I think the notion that "nobody will apply EM" is absurdly hyperbolic.
If a global pandemic, a jobs report predicting a cataclysmic labour market in 10 years' time, record high burnout rates and nearly daily feedback from current residents and practicing attendings that the actual practice of emergency medicine sucks @ss couldn't discourage >1500 lemmings from applying EM annually...
...why do we suddenly think that a transition from predominantly 3 years to all 4 year residencies will be the nail in the coffin?
Particularly when you consider that all AOA programs were 4 years before the merger, and 4 year programmes in places like New Haven, CT, Providence, RI, Rochester, the Bronx and fxcking Newark NJ fill on a regular basis despite being in 3rd tier cities in the freezing northeast, I don't think this is going to suddenly make med students consider doing IM or another specialty.
Honestly I think the notion that "nobody will apply EM" is absurdly hyperbolic.
If a global pandemic, a jobs report predicting a cataclysmic labour market in 10 years' time, record high burnout rates and nearly daily feedback from current residents and practicing attendings that the actual practice of emergency medicine sucks @ss couldn't discourage >1500 lemmings from applying EM annually...
...why do we suddenly think that a transition from predominantly 3 years to all 4 year residencies will be the nail in the coffin?
Particularly when you consider that all AOA programs were 4 years before the merger, and 4 year programmes in places like New Haven, CT, Providence, RI, Rochester, the Bronx and fxcking Newark NJ fill on a regular basis despite being in 3rd tier cities in the freezing northeast, I don't think this is going to suddenly make med students consider doing IM or another specialty.
I prefer people are picking the field because it's what makes them happy, potentially the only thing that makes them happy. Did you all think about it in the terms of lost in cost out? You thought about it as a business decision?Politely disagree, here's why:
The kids coming out have a strong sense of: "I gave enough. I want out and FAST. 4 years is a dealbreaker, but you can't get less than 3 anywhere, doing anything. If that's the floor, then that's the floor."
Honestly I think the notion that "nobody will apply EM" is absurdly hyperbolic.
If a global pandemic, a jobs report predicting a cataclysmic labour market in 10 years' time, record high burnout rates and nearly daily feedback from current residents and practicing attendings that the actual practice of emergency medicine sucks @ss couldn't discourage >1500 lemmings from applying EM annually...
...why do we suddenly think that a transition from predominantly 3 years to all 4 year residencies will be the nail in the coffin?
Particularly when you consider that all AOA programs were 4 years before the merger, and 4 year programmes in places like New Haven, CT, Providence, RI, Rochester, the Bronx and fxcking Newark NJ fill on a regular basis despite being in 3rd tier cities in the freezing northeast, I don't think this is going to suddenly make med students consider doing IM or another specialty.
I prefer people are picking the field because it's what makes them happy, potentially the only thing that makes them happy. Did you all think about it in the terms of lost in cost out? You thought about it as a business decision?
I say this without trying to be arrogant, and please do not read it that way - we are very different if you approached the field that way. But it might also be why I'm almost 10 years out of residency and still loving going to work as many days as possible a month.
I want to point out that the AOA programs never filled... And the 4 year issue was undoubtedly a factor in that.Yep exactly. People forget there used to be tons of 4 year AOA programs that had no trouble filling during the match. Now the will change likely convince some people choosing between EM and other specialties to not pick EM and pick other specialties but there's still plenty of other people that are EM or bust that will never stop applying no matter what anyone says. That's not even considering all the IMGs happy to do a 4 year residency.
Agree completely.No arrogance was perceived, bro.
I also share your desire for "we want the ones who want to be here", but I have the strong sentiment that the kids don't see it that way.
Me? Any 4 year program was a "no" for me. I was competitive for other things (Gas, Rads) but I wanted "to do the Indiana Jones things".
We don't do so much Indiana Jones stuff anymore.
Add to the fact that combined IM + fellowship programs are becoming a thing. Heck, there are programs out there now that can produce someone boarded in IM + nephro in 4 years. And this proposal would make it so that if you want to be EM + EMS boarded, you would need to spend FIVE years in GME? Alternatively, if you want to be EM + tox boarded you would need to spend SIX years?? Make it make sense.All of a sudden, you’re “only” 2 more years from becoming cardio/GI/Onc.
Anesthesia also becomes more attractive with its better lifestyle. They have ASC jobs with no overnight calls.
Isn't EM supposed to be a generalist field? I don't understand why you wouldn't want an applicant with a large variety of interests. Doing a fellowship or trying out other rotations in med school should have the potential to make someone a better EM physician, not worse.I prefer people are picking the field because it's what makes them happy, potentially the only thing that makes them happy. Did you all think about it in the terms of lost in cost out? You thought about it as a business decision?
I say this without trying to be arrogant, and please do not read it that way - we are very different if you approached the field that way. But it might also be why I'm almost 10 years out of residency and still loving going to work as many days as possible a month.
Exactly my thoughts as a medical student.If the only option for EM is 4 years or choose a different specialty... It might not make a ton of people change their minds.
I'm certain it will make more people change specialties than you think though.
It might have convinced me to change specialties had I been forced to do 4 years.
I intentionally picked the best 3 year specialty fit for me. If EM wasn't an option at 3 years, I would have compared EM to other 4 year specialties.
In fact, if I was a medical student now, I would probably be so put off by the fact so many EM docs thought 3 years was reasonable for themselves but expect me to do an extra year, I would conclude these are not the people I want to work with the rest of my career. Part of the reason I chose EM was because the docs seemed like my type of people. I fit in with them.
Em had no problem filling 4 years when it was still in the golden age of EM now look at it pick a city like Denver work 4 years and make 275k doing night shifts
IM is a way better deal with so many more options
Not to mention EM fellowships suck
I picked it because I liked it. Now my best shift is the absolute slowest rural shift I can work...I prefer people are picking the field because it's what makes them happy, potentially the only thing that makes them happy. Did you all think about it in the terms of lost in cost out? You thought about it as a business decision?
I say this without trying to be arrogant, and please do not read it that way - we are very different if you approached the field that way. But it might also be why I'm almost 10 years out of residency and still loving going to work as many days as possible a month.
I think if you don't have at least one residency shift where you're doing DL because you ran out of VL blades, maybe you didn't go hard enough.I mean if that's how few emergency patients are seen at the 120K visit residencies think about how bad it is at 60K visit residencies.
The fix for bad residencies is to shut them down.Basically the people who come on here every day to bitch and moan about the state of EM and the proliferation of bad residencies... are now on here to bitch and moan about the proposed fix for said bad residencies.
Nothing is perfect. There will be unexpected good and bad consequences if this thing passes. I wholeheartedly support it.
And how does one realistically get that done?The fix for bad residencies is to shut them down.
I picked it because I liked it. Now my best shift is the absolute slowest rural shift I can work...
I mean it’s a great way to get out of the PIT. Bunch of protected time. You can still work some clinical shifts.Truth be told if that individual wont take it someone else will. Yeah it’s bad but if the pot is sweet enough anyone in this forum would take it.The problem is with the proliferation of any residency at this point. There is no need. Every new program needs a PD and someone seasoned enough to know better and take the job including the entourage of core faculty members is directly contributing to the problem.
Basically the people who come on here every day to bitch and moan about the state of EM and the proliferation of bad residencies... are now on here to bitch and moan about the proposed fix for said bad residencies.
Nothing is perfect. There will be unexpected good and bad consequences if this thing passes. I wholeheartedly support it.
How many of these HCA and CMG programs are actually paying enough attendings for educational non-clinical work? I have a hard time believing that many of them are paying for enough non-clinical time given that it would hurt their bottom line.I mean it’s a great way to get out of the PIT. Bunch of protected time. You can still work some clinical shifts.Truth be told if that individual wont take it someone else will. Yeah it’s bad but if the pot is sweet enough anyone in this forum would take it.