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Another exciting new residency program!

Fox800

Go to the ER now to see if you have coronavirus.
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Oligodinero

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Fox800

Go to the ER now to see if you have coronavirus.
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At this point, there are going to be more residency programs than Waffle House locations. Which makes sense, since so many of our patients customers view the emergency department as a drive-through for Dilaudid, Percocet, and work notes. Doesn't matter if you're working a code on an 8 year-old, they'll yell at you at the hallway because it took you 38 minutes to see them for their chronic ankle pain for 3 years.
 
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gamerEMdoc

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You can judge programs by their quality and volume of patients per resident, but population isn't a fair judge. Our rural program sees more patients in our ED per year than the entire population of our city. Some places have zero hospital competition and a huge catch area. We have a higher ED volumes than some city programs that have more residents per class than us. It makes no sense if you look at our "city" population. It all depends on the size of your catchment area.

I've lived near Temecula, when stationed at Pendleton. its actually a pretty nice place. I'm gonna guess that this will be a terrible CMG residency bc that seems to be the trend, but if it wasn't and they had an ED that sees an appropriate volume, level 1 trauma, etc etc etc it would be fine.
 
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namethatsmell

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This shop's website proudly advertises "ER Reserve:

ER Reserve lets you request a time (up to 12 hours in advance) in the Emergency Department for non-life-threatening injuries or illnesses such as: flu, sore throat, earache, cough or cold, muscle strains and sprains."

Sounds like a clinical goldmine for trainees.
 
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Fox800

Go to the ER now to see if you have coronavirus.
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This shop's website proudly advertises "ER Reserve:

ER Reserve lets you request a time (up to 12 hours in advance) in the Emergency Department for non-life-threatening injuries or illnesses such as: flu, sore throat, earache, cough or cold, muscle strains and sprains."

Sounds like a clinical goldmine for trainees.

Everything you need for your new career as an urgent care physician working alongside midlevels for $130/hour.*


*Roughly what USACS pays emergency physicians in the Front Range of Colorado
 
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Hamhock

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ACGME and the RRC are squarely to blame here, and I suspect are complicit.

Yes, the RRC deserves blame -- but so do we!

For years now, I feel like one of the few voices in this forum trying to point out that:

1. not all EM programs train residents to a level of proficiency (the immediate reply in this forum: but but the RRC! all EM programs are certified as adequate by the RRC!)....really? The inadequate programs used to be primarily within the osteopathic world, but there were plenty of inadequate programs in the allopathic world also. It's bittersweet to see this issue finally get acknowledged.

2. not all EM programs have adequate training in trauma. Trauma is not ATLS.

EM docs and the RRC share a significant part of this responsibility....yet we just complain about the CMGs and avoid acknowledging our complicity.

HH
 
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Rekt

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You can judge programs by their quality and volume of patients per resident, but population isn't a fair judge. Our rural program sees more patients in our ED per year than the entire population of our city. Some places have zero hospital competition and a huge catch area. We have a higher ED volumes than some city programs that have more residents per class than us. It makes no sense if you look at our "city" population. It all depends on the size of your catchment area.

I've lived near Temecula, when stationed at Pendleton. its actually a pretty nice place. I'm gonna guess that this will be a terrible CMG residency bc that seems to be the trend, but if it wasn't and they had an ED that sees an appropriate volume, level 1 trauma, etc etc etc it would be fine.

We're far beyond worrying about training being an issue. It doesn't matter if this place offered the best training in the country. We're just not going to have any place for residents to go. The supply is getting far far too great. The demand isn't there. We should put a hiatus on all new programs until we can go through the real numbers and find what our true need is, if any at all.

I'm surprised how no one really gets upset at this. This is destroying emergency medicine more than anything else by far
 
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RustedFox

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MechEDoc

maybe minor rocket surgery...
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This shop's website proudly advertises "ER Reserve:

ER Reserve lets you request a time (up to 12 hours in advance) in the Emergency Department for non-life-threatening injuries or illnesses such as: flu, sore throat, earache, cough or cold, muscle strains and sprains."

Sounds like a clinical goldmine for trainees.

So is this going to be a NP / Family medicine or emergency medicine residency?
 
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TheComebacKid

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We're far beyond worrying about training being an issue. It doesn't matter if this place offered the best training in the country. We're just not going to have any place for residents to go. The supply is getting far far too great. The demand isn't there. We should put a hiatus on all new programs until we can go through the real numbers and find what our true need is, if any at all.

I'm surprised how no one really gets upset at this. This is destroying emergency medicine more than anything else by far
When ACEP is in the pockets of CMGs, what did we expect?

I've lived near Temecula as well. It is one of the best parts of the country, great wine, close to some fun outdoors stuff, and a stone's throw from San Diego and LA. Despite how horrific the training will be there, they will likely fill all their spots.

AAEM has been vocal about this, but I seriously don't understand why the rest of the EM world is not up in arms about this. If you are a physician and you are a part of CMG leadership, you are essentially decreasing your own pay and threatening your very own job security by not speaking out to stop this.

Part of the problem, I think, was the "bleeding heart" mentality of many EM physicians to the public health needs of the country over the past decade. Too many of our own people said, "we have to fill the void so people have access to board certified EM physicians". Nobody spoke up enough AGAINST IT, mid levels proliferated, and you have the cluster that is now residency grads (from reputable good programs) not actually having jobs.

Furthermore, CMGs are very volatile. What happens when a CMG residency goes under? The residents get screwed. You would have to be a ***** to not only support one of these residencies, but to train at one of them.
 
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blue.jay

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Eventually these residencies will be unable to fill their classes. Pay will drop, EM will go in the dumpster for a number of years and lots of these places will close when. I suspect the time between now and a market correction will be pretty painful for all of us in the field.

This a distraction by CMG from the real threat of midlevel expansion. As the NP graduates swell in number they are becoming more malignant/virulent; trying to encroach every lucrative field.
 
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bikERdoc

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Nobody spoke up enough AGAINST IT, mid levels proliferated, and you have the cluster that is now residency grads (from reputable good programs) not actually having jobs.

Just curious, do you have actual evidence of this? Covid aside, I've not heard of new grads actually not finding work. I can imagine a world where that's the case, but for the most part when I graduated 5 yrs ago, jobs were plentiful. I imagine jobs are still out there, albeit on hold at the moment.

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gamerEMdoc

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Yeah for all the doom, I havent ever had a resident not find a full time job wherever they wanted to live. No finding a non-cmg job, thats much trickier depending on where they want to go live after residency. Some places there just isnt really another option.
 
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docB

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I don't think that the CMGs are driving this. They get no short term financial benefit. They will see a long term increase in labor supply but most CMGs don't seem to be good at looking at the long term. I think this is being driven by the hospital corporations.
 
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RustedFox

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I don't think that the CMGs are driving this. They get no short term financial benefit. They will see a long term increase in labor supply but most CMGs don't seem to be good at looking at the long term. I think this is being driven by the hospital corporations.

Sure they do.
Easier to meet metrics while only paying a resident's salary = easier to steal more money in their bonuses for "managing the department so well".
 
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Rekt

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I don't think that the CMGs are driving this. They get no short term financial benefit. They will see a long term increase in labor supply but most CMGs don't seem to be good at looking at the long term. I think this is being driven by the hospital corporations.

Residents are free labor. Instead of hiring new docs just start a residency program. You essentially have 100% compliant physicians working for minimum wage. I doubt they put any financial resources beyond the bare minimum in education effort for them. They don't care about where they go after.
 
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TheComebacKid

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Just curious, do you have actual evidence of this? Covid aside, I've not heard of new grads actually not finding work. I can imagine a world where that's the case, but for the most part when I graduated 5 yrs ago, jobs were plentiful. I imagine jobs are still out there, albeit on hold at the moment.

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COVID is an important player because it basically exposed the over saturation of our specialty. In the COVID era, yes, I have heard of multiple people A) not being able to find jobs in certain markets (even at CMG sweatshops) and B) having either their hours cut significantly or worse their contracts completely rescinded.

Pre-COVID, people had jobs, but it wasn't always great situation. If you want to work in Denver, you are at the Mercy of USACS and looking forward to raking in 120/hr. Over saturation with residency grads doesn't help this situation. Locums has been drying up for awhile. And while I don't think anyone is jobless, the opportunities are fading and the wage trajectory does not look great.

Supply and demand economics just simply does not favor us in this situation. Supply is far exceeding demand by all available metrics. In tight markets, you take the terms the CMG overlords give you, or you don't get to work in a particular location. Although I didn't apply for jobs 5 years ago, I suspect things were more plentiful at that time.
 
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EM:RAT

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I worked at that place (Inland Valley Medical Center in Wildomar) about 5 years ago. As an attending the experience was great. I saw around 2 patients/hour, probably admitted close to 50% of them. The PA ran a busy fast track section and RME, leaving the MDs to focus on the higher acuity patients and more complicated workups. It was always super busy and the acuity was high. I definitely did major procedures there more often than during my residency (UCSD). With that said, I share the concerns of this being inadequate as a training site. It's only a 25 bed ER with an annual volume of 44k and depending on the number of trainees per year I question whether this is a busy enough to support a residency. Not to mention, I wouldn't expect the quality of bedside teaching to be stellar at a CMG sponsored residency either.
 
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GeneralVeers

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At our newly established residency (residents started last month), we have NO TRAUMA rotation for them yet. How does a program get ACGME accreditation without a plan for a trauma rotation? I was told that residents might have to travel to San Diego for it next year, and pay out of pocket for travel. I simply can't believe this is real.....
 
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SamtheWise

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I'm going to seek employment in one of these new residencies and teach the customer service curriculum. Lean into it. Chronic back pain? That sucks sorry my imaging metrics won't support me ordering an MRI but here have 50 percocet, 20 valium and see your PCP! 85 year old smoker with chest pain, a wide mediastinum on CXR and BP 220, that seems bad, but your EKG and first troponin look OK, so here have 50 percocet and see your PCP for a stress on monday. Uninsured IVDU with a new murmur and a fever? Document malingering and drug seeking behavior so they don't get a survey, then DC with no tests ordered.
 
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NurWollen

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I'm going to seek employment in one of these new residencies and teach the customer service curriculum. Lean into it. Chronic back pain? That sucks sorry my imaging metrics won't support me ordering an MRI but here have 50 percocet, 20 valium and see your PCP! 85 year old smoker with chest pain, a wide mediastinum on CXR and BP 220, that seems bad, but your EKG and first troponin look OK, so here have 50 percocet and see your PCP for a stress on monday. Uninsured IVDU with a new murmur and a fever? Document malingering and drug seeking behavior so they don't get a survey, then DC with no tests ordered.
Wait is it really this bad or are you being hyperbolic to better illustrate your point?
 
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Maybe. Maybe not I dunno come be my admin fellow at the new HCA Northeastern Florida Residency and we can see together.

"Come be my admin fellow"

Hilarious! These are the carrots being dangled in front of senior residents as the new means to an end (a full time job). CMG wins both ways - they get an administrative workhorse for a year, and then will hire that graduate for a full time clinical position with... surprise, surprise... administrative duties as an unspoken requirement.

Three years later they're being "asked" (read: voluntold) to be a medical director at the newly acquired sweatshop contract two states over.

"What you don't want to take such an opportunity? Why would anybody say no? Maybe you're not the team player we thought you were!"
 
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