ACGME proposing changes to EM residency requirements

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KGflyboy said:
Anybody who thinks 4 years is a reasonable minimum, which it is not, needs to put their money where their mouth is.

Go to your admin tomorrow and tell them to fire every single NP and PA because we need more highly trained people in the ED, not lesser trained people. There are a lot of places who are perfectly content letting midlevels work with little to no oversight to help the bottom line... So which is it? Is it safe to have people caring for patients in the ED with such a low amount of training, or do we need even more training than the usual e year residency.

You can't have it both ways.

You can't continue to hire people with minimum education and training while simultaneously requiring 4 years of residency for physicians going forward.

In my opinion, it does not take 4 years to train an EM physician. This is a ridiculous idea.

I agree that this will drive down interest in EM and potentially result in some programs closing. That's great for supply and demand, but this is horrifically unfair to future residents.

The vast majority of attendings in this forum have claimed had significant consensus over the years that 3 years is plenty long enough. Look back at old posts. People claiming 4 years are needed were the traditionally the minority.

I would love to shut down the crappy programs opening over the last several years, but I cannot get behind the 4 year plan.
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I specifically applied to exactly zero four year programs.
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JacobMcCandles said:
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.
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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.

After all... This proposal won't just affect your hospital. It affects all of them.

All of these residents doing 4 years of training will eventually go out and apply for jobs only to realize their physician staff hours are constantly being cut in order to save money for corporate overlords who think they can be replaced by a mid-level.

That extra year of training won't really come into play when the hospital is content with a brand new NP seeing patients in between testing other patients at her Botox, IV infusion, and hormone pellet boutique.

This entire proposal exemplifies how disconnected the ivory tower type of doc is from actual emergency medicine.
 
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why stop at 4, let's make it 5! Then graduates will be even better trained. Honestly though, I went to a solid 3 year program and ranked 4 years lower. Felt burned out in residency and certainly as an attending, and much happier (and healthier) now in Pain. The issue with MD/DO is that they keep adding time to it (an increasing percentage of med students now take a 5th year to do research, etc). Adding more time to training/school isn't having any significant pay off. Makes the NP/PA route (with the amazing career latitude to change specialties) all the more appealing. Even some of the EM fellowships are low yield in my opinion with respect to career mobility - EMS, tox, ultrasound - you're still doing majority of your time in EM in fellowship and beyond (and thus absolutely no need for a 4th year during residency).

Regardless of when it happens, first year as an attending is where a lot of the learning is. For me, transitioning from a level 1 academic residency to single coverage community was formative. EM was a relatively good 'deal' when it was 3 years, but now at 4 anesthesia is the way to go.
 
KGflyboy said:
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.
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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.
 
JacobMcCandles said:
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.
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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.

If it hasn't made it's way to your area, just give it a few years. It will. Right now hospital bylaws can supercede state laws and require physician supervision, but that supervision is often in name only. Within my group, some of us try real hard to take the sicker patients before a mid-level can sign up, but you would be surprised how many physicians are content with midlevels doing more work to make their jobs easier.

Many hospitals now have NPs and PAs doing intubations and central lines and managing sicker patients.

Many academic hospitals have 1 year fellowships for midlevels to gain more training managing these patients and performing the procedures.

If they can do it in 1 year, it's hard to justify 4 years for docs.
 
JacobMcCandles said:
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.
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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.
 
EctopicFetus said:
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.
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Aren't you in AZ?
 
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."
 
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larpleston said:
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."
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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.

The NP issue is real but that is besides the point. The economics of MLPs is the issue.

I dont think one needs 4 years to be an EM doc but again i support it.. as one of my residents told me.. 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.
 
EctopicFetus said:
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.
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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.
 
hoot504 said:
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.
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Leadership that wants to protect themselves.
 
hoot504 said:
How so?
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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.
 
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).
 
CliveStaples said:
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).
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The problem is all the caveats and nonsense sim and the million ways to get around the requirements.
 
EctopicFetus said:
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.
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Extremely uncharitable interpretation of their motivations. Can’t say you’re wrong, but doubt this is much of what’s driving the changes.
 
hoot504 said:
Extremely uncharitable interpretation of their motivations. Can’t say you’re wrong, but doubt this is much of what’s driving the changes.
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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.

What do you think is driving the change?

IMO if it is anything other than 3 years is just not enough and the current crop of residents are weak and not doing a good job then the only other answer that makes sense is some framing of greed. But I am genuinely curious your thoughts.
 
There is some amazingly shortsighted takes here.

Unless you intend to change how the ACGME works, they can't close programs you don't like because you don't like them. You want to close the proliferation of crap programs? This is the cost. This is how you do it. The mistake was starting to give these places a thumbs up 10-12 years ago when they could meet the written criteria but not pass the sniff test. I don't have a time machine and ACGME doesn't have another mechanism except credentialing rule changes. They're credentialed and you need to raise the credentialing thresholds because they met the old ones years ago.

It's hard to legislate objectively what is crappy. But making the requirements hit the crappy places at exactly their weakest point (they're small volume and goal of churning people out) is a good start. Make it require more visits and slow the churn and perhaps it's flat out disqualifying for some HCA places and economically unsustainable for others

You all say you want the **** places closed. This is the cost to do so. Now it's not the time to show you weren't ready to do what it takes because I hear the cost and I know its far from ideal and I'm still like:
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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.
 
Lexdiamondz said:
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.
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This
 
Lexdiamondz said:
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.
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The open spots last year oppose your absurdity.
 
Lexdiamondz said:
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.
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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."
 
RustedFox said:
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."
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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.
 
Lexdiamondz said:
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.
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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.
 
DocEspana said:
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.
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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.
 
So for those who don't realize how bad its gotten at many residencies here's a med student review of a typical 4th year rotation:

Keep in mind this is at Baystate a level 1 trauma center at sees 120K patients and is widely considered to be a great program.

Medical Student Residency Program Reviews

Not a lot of community time, max 3 months throughout program if you use all of your electives for community rotations. Insane levels of boarding at times between psych and medicine (waited 4 hours to see a patient on shift because upstairs beds were full). So much critical care that it can get draining on residents, sometimes they need a break from the acuity and it just doesn't arrive. Off-service rotations frontloaded (almost 50% off-service 1st year) with sporadic ED time after ED orientation month. Cerner can be difficult to navigate, even for the experienced residents. Many sick patients in hallway beds on telemetry due to ED volume. Former resident here - I think this program needs a bit of a change. ED admin has had wild rapid turnover and there's been a shift from focusing on learning to focusing on pushing people through and grinding, which is expected, but shouldn't be at the expense of training. Lots of burnout from nursing to attendings (which is talked about, but nothing is done about it). There is such a disconnect between nursing and residents, most don't spend time with each other outside of work and there's no real "bond" with them. The nursing culture is toxic especially if you are a woman - I would receive so much pushback from nursing, passive aggressive comments whereas my male coresidents wouldn't. Most attendings are really nice and approachable but on shift learning is tough when they have PT/CM/Psych patients that they are spending half their shift making sure they have all their things in. The acuity is insane but the overall culture needs a bit of a revamp. The "wellness" things such as wellness conference is 4 hours at an attendings house typically requires you to drive 35-40 minutes one way, and is exhausting. Sure it is nice to see your coresidents outside of work but when they are preaching eating healthy, sleep, workout, but then provide unhealthy food, booze, and take up almost 6 hours often on your only true day off. Also most attendings are Baystate grads so you will learn the "baystate way"
 
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 problems won't be fixed if you just shut down all the bad programs.
 
20 years ago, every ED program was considered to provide good training. That was because the criteria were so strict that crap programs didn't meet the burden and so never got credentialed. Then CMGs sat down and figured out that the criteria had unwritten assumptions about the setting of the training and that mid-size community places with a couple of farmed out rotations to larger academic sites met all of the written criteria. Since getting credentialed is about checking the boxes, without some certificate of need process, residencies proliferated. I feel like the merger between MD and DO residencies probably distracted attention from this expansion but have no actual evidence to back that up.

Then COVID happened and volume dropped off a cliff and trainees spent a year and a half seeing nothing but respiratory failure, VTE, and ACS/CVA. And then pass rates started falling and voices started shouting about residency quality and oversupply. And so a committee was convened to look at resident education and that committee realized a lot of residencies looked nothing like what they remembered of their training. And so they set about trying to recreate their training plus updating for things that didn't really exist when they trained (rise of waiting room admissions, telehealth beyond being telemetry for EMS, supervisory models where APPs aren't just seeing low acuity pts, etc). And then they tallied up how long training would take. And the 3 yr programs thought it would take ~42 months and the 4 yr programs thought it would take over 50. And since there isn't a mechanism in place for adding half a year to programs, they went with 48 months.

And it could be for the free-ish labor or because an illuminati of 4 yr program faculty secretly control all of EM (which makes the rise of CMGs and APPs seem sort weird) but it's a lot more likely that the needs of EM graduates and what the residency experience was like has changed from when you trained. And since I doubt they're going to take another bite of the apple soon, they went with a big bite.

Just because training is moving to 4 years doesn't mean that the 3 yr program you did sucked or left you unprepared. It could also be that the job and the environment of training is radically different from what experienced coming out.
 
Truth is simple:

1) more American grads will avoid EM
2) more IMGs will scramble/soap into EM
3) lower board scores because of 1 and 2
4) residency spots will still go unfilled
5) bad residencies will still be around
6) current EM physicians will continue to want to retire or leave the field asap
7) Academia will continue to spiral down because of all the above (academia pays crap and is flooded with patients)

The goal is just not care and keep going while keeping your head down and pocketing as much cash as possible. Our field is dying and no amount of effort is going to resuscitate this patient.

Hospital Corporate America does not care about Emergency Medicine.
 
alpinism said:
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.
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I want to point out that the AOA programs never filled... And the 4 year issue was undoubtedly a factor in that.

Many DO applicants strongly prioritized the MD residencies over DO residencies because they did not want to do 4 years.

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.

They didn't come across as greedy people trying to maximize their income by sacrificing future residents.

I mean... I'm cool with less people applying. I just worry that this will not limit the number of programs or residents as much as it will decrease the quality and caliber of EM residents.

It would be very easy to mandate better training by requiring residents see more patients or by adding other requirements. It doesn't require mandating all programs add a 4th year.

Many programs are perfectly capable of providing good training in 3 years.

This proposal smells of greed.

RustedFox said:
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.
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Agree completely.

Somebody more motivated than I am should make a poll to see how many practicing EM docs would have chosen a different specialty of the only EM options at the time were all 4 years.
 
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Prehealth1011 said:
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.
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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.

DocEspana said:
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.
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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.

KGflyboy said:
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.
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Exactly my thoughts as a medical student.

This cycle and last cycle HUGE amounts of DO students applied EM, so that their numbers almost surpassed USMD students. Last cycle, some DO schools had EM as their top matched specialty. This is likely due to the compensation to length of training ratio, and I expect a change like this would cause the specialty to be less attractive to DOs.

Plus, the discussion is to make EM into a straight 4 years, not a 1 + 3 like anesthesia. Currently, EM is a fairly attractive option to those who have completed an intern year OR another residency and want to try another specialty. It's easy to match and only 3 years. If this change goes through, why would someone with an intern year apply to EM at all? That would make their GME training at least five years in total. They might as well apply to any other specialty where the intern year would count towards something and try to match into a reserved position OR go for a 3 year categorical.
 
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
 
Brigade4Radiant said:
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
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What he means is: "EM had no problem filling four year programs in the golden age."

Not: "Four years ago, during the Golden age..."


Back to your regularly scheduled bantering, everyone.
 
All this talk about "if it were 4 years when I was applying I wouldn't have chosen EM" is part of the problem. This kind of thinking is shortsighted and contributes a lot to the burnout we see. Of course it's often logical to choose 3 over 4 when that's an option but when they're all 4 no one should care. EM is one of those specialities where you should only go into it if you can't see yourself doing something else. Unfortunately most of us make this crucial decision with an immature 20s brain. If your mindset is to make a quick buck as fast as possible and hit FIRE, EM has not been very appealing for quite some time now except rare locums or boonies work.

The more I go through my career I realize certain personality types will always be discontent and prone to burnout. My bet is a lot of them were the ones to heavily prioritize 3 over 4 years of training, overlooking a better fitting specialty. I was also somewhat guilty of that. Yes EM has its fair share of intrinsic factors leading to burnout, but let's not discount the individual in the equation.

With that said, agree that given the state of the field this change will unlikely alter the general trajectory into the trash can. I can see a small percentage of super motivated and determined future PDs, Chairs, rah-rah SDG types doing well while the rest are bottom tier quality.
 
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DocEspana said:
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.
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I picked it because I liked it. Now my best shift is the absolute slowest rural shift I can work...
 
alpinism said:
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.
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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.
 
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.
 
hoot504 said:
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.
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The fix for bad residencies is to shut them down.
 
hopefulgasman said:
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.
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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.
 
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