Anyone want to guess at the number of unfilled spots this year?

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WuMedic

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Slow shift tonight in my ER, and my partner and I are chatting about the Match (if it stays like this for another hour, I'm probably gonna cut him loose). On Monday morning, we will learn how many spots are unfilled for the SOAP. On Thursday evening, we will learn how many spots are left for scramble.

My guess: 150 unfilled Monday, 35 scramble Thursday
His guess: 350 unfilled Monday, 50 scramble Thursday

My rationale: Applications are slightly up for USMDs this year and significantly up for USDOs and IMGs. PD's are probably interviewing more/interviewing in more "bands" so they aren't just all interviewing the same group of top tier med students. Some PD's who previously were not willing to do so, might be more willing to overlook a USMD red flag than have to rank an IMG higher. Similarly, some programs that traditionally didn't consider USDO or IMG might start doing so. Anecdotally, a community program near me interviewed IMGs for the first time ever this year (desirable location, decent program, SOAPed for the first time last year), though my friend said he wasn't sure if their program was going to rank any (he's just a prm there as he likes teaching residents so not someone who makes decisions). They might prefer to go to the SOAP stage to snag a well qualified USMD that just didn't have EM as his specialty of choice or needs to be in this city for a failed couples match, etc. (It was at a holiday party I ran into this guy so I don't know what they decided to do nor do I think he would be at liberty to tell me.) I predict overall we will do better than last year, and even the year before as programs figure out what kinds of candidates are within their grasp in this new world, but nowhere near 5-10 years ago when we were filling nearly every spot.

His rationale: It will be better than last year, and might approach the year before, but not more than that. Too many hard headed PD's who are unwilling to consider IMGs (and to a lesser extent DOs) and who are close enough to the years we were filling every spot nationwide that they think the last 2 years were just an anomaly and are unwilling to believe their program will need to fill form lower tier candidates. Tons of top tier students still doing 20+ interviews. IMGs will be a factor only at the lower tier programs.

Anyone want to join the game and make a wager as to what the numbers will be this year? I'll send the person with the closest guess a turkey sandwich and a pudding cup!

*Full Disclosure* : Neither of us work at any sites with residents, this is all just conjecture based on second, third, and fourthand rumblings we are hearing.
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My guess: IDGAF.
My rationale: This specialty isn't that special, and is effed no matter how many spots do or don't fill.
 
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WuMedic said:
Slow shift tonight in my ER, and my partner and I are chatting about the Match (if it stays like this for another hour, I'm probably gonna cut him loose). On Monday morning, we will learn how many spots are unfilled for the SOAP. On Thursday evening, we will learn how many spots are left for scramble.

My guess: 150 unfilled Monday, 35 scramble Thursday
His guess: 350 unfilled Monday, 50 scramble Thursday

My rationale: Applications are slightly up for USMDs this year and significantly up for USDOs and IMGs. PD's are probably interviewing more/interviewing in more "bands" so they aren't just all interviewing the same group of top tier med students. Some PD's who previously were not willing to do so, might be more willing to overlook a USMD red flag than have to rank an IMG higher. Similarly, some programs that traditionally didn't consider USDO or IMG might start doing so. Anecdotally, a community program near me interviewed IMGs for the first time ever this year (desirable location, decent program, SOAPed for the first time last year), though my friend said he wasn't sure if their program was going to rank any (he's just a prm there as he likes teaching residents so not someone who makes decisions). They might prefer to go to the SOAP stage to snag a well qualified USMD that just didn't have EM as his specialty of choice or needs to be in this city for a failed couples match, etc. (It was at a holiday party I ran into this guy so I don't know what they decided to do nor do I think he would be at liberty to tell me.) I predict overall we will do better than last year, and even the year before as programs figure out what kinds of candidates are within their grasp in this new world, but nowhere near 5-10 years ago when we were filling nearly every spot.

His rationale: It will be better than last year, and might approach the year before, but not more than that. Too many hard headed PD's who are unwilling to consider IMGs (and to a lesser extent DOs) and who are close enough to the years we were filling every spot nationwide that they think the last 2 years were just an anomaly and are unwilling to believe their program will need to fill form lower tier candidates. Tons of top tier students still doing 20+ interviews. IMGs will be a factor only at the lower tier programs.

Anyone want to join the game and make a wager as to what the numbers will be this year? I'll send the person with the closest guess a turkey sandwich and a pudding cup!

*Full Disclosure* : Neither of us work at any sites with residents, this is all just conjecture based on second, third, and fourthand rumblings we are hearing.
Click to expand...
425 unfilled. 75 post soap
 
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Not as high as last year, but more than 2022
 
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WuMedic said:
I predict overall we will do better than last year, and even the year before as programs figure out what kinds of candidates are within their grasp in this new world, but nowhere near 5-10 years ago when we were filling nearly every spot.
Click to expand...

"Doing better". The only way we can "do better" is if thousands of spots go unfilled for many years in a row. Spots filling is the opposite of what this specialty needs. There are far too many spots available and programs need to be shut down for inability to fill (though we know they all will...). I am hoping for hundreds of open spots following the SOAP.
 
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Programs need to fill. PDs don't want to be scrambling any more than medical students do.

I suspect they'll have tweaked their interview invitation strategies to improve depth and reduce the chance of going all the way to the end of the list.
 
trackrunner321 said:
"Doing better". The only way we can "do better" is if thousands of spots go unfilled for many years in a row. Spots filling is the opposite of what this specialty needs. There are far too many spots available and programs need to be shut down for inability to fill (though we know they all will...). I am hoping for hundreds of open spots following the SOAP.
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Same. Hoping for 500+ open spots after soap.

In reality, there will only be a handful left after soap.
 
1710121434452.png


My hope is this is me standing next to the match results

If you wanna see change you gotta let it burn
 
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I agree that what's needed for a massive change is for there to be hundreds if not over 1k spots unfilled after the scramble, but the reality of the situation is that will never happen.

There are enough foreign docs who see a US residency as a way to punch their golden ticket into a high paying career in the states and as a way for their families to immigrate here that there will always be people willing to switch specialties into EM (or other specialties) just to get state-side. Don't get me wrong, there are tons of qualified foreign docs, but for every one of those, there are even more who are not qualified to practice in the US, or at least shouldn't be qualified to do so.

Until the supply of foreign grads dries up, we will never see the number of unfilled spots we need to see for the lack of docs going into EM to be the catalyst for change we need. I think we are more likely to see other problems act as the "catalyst" before we see this one.
 
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What shocks but doesn't surprise me is how many of my former co-residents and co-attendings don't understand this simple Econ 101 problem. The supply survey is fuxxored, and no we don't need more EM physicians.

Mind boggling.
 
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WhatJobDoIPick said:
What shocks but doesn't surprise me is how many of my former co-residents and co-attendings don't understand this simple Econ 101 problem. The supply survey is fuxxored, and no we don't need more EM physicians.

Mind boggling.
Click to expand...

It's a feature, not a bug. Econ, from the business perspective, wants to optimize cost, aka, pay as little as possible (decrease cost) to make as much as possible (increase profit). Can't increase reimbursements, so the suits need to decrease cost. So either increase the supply of physicians, or decrease the demand. Demand ain't going down anytime soon with our aging population, guess what the only input variable to manipulate is...
 
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about 137 open spots. supposedly all the west coast programs filled
 
- shrug -

The better characterisation of the incoming class will come once the demographics are published and show the percentages of relatively "undesirable"/"less-qualified" trainees.
 
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WhatJobDoIPick said:
The delusion on reddit is incredible. May meet criteria for shared delusion disorder
Click to expand...

They're redditarded. Really, really are.
If you say anything contrary to the hivemind of students, rezzies, and young attendings, you "can't be right, just can't be".
 
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so officially 137 (idk where the other two not accounted for on reddit came from).

I noticed some really good (but not great) programs had openings - i guess they didnt adjust interviewing.

but more concerning some REALLY REALLY ****ing suck ass programs that I know about filled 100%. Which is terrifying. Well known name brand programs have openings but HCA bumble**** community hospital filled its 5 residents per year???? THey adjusted *very* well and we will suffer for it.
 
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DocEspana said:
so officially 137 (idk where the other two not accounted for on reddit came from).

I noticed some really good (but not great) programs had openings - i guess they didnt adjust interviewing.

but more concerning some REALLY REALLY ****ing suck ass programs that I know about filled 100%. Which is terrifying. Well known name brand programs have openings but HCA bumble**** community hospital filled its 5 residents per year???? THey adjusted *very* well and we will suffer for it.
Click to expand...

I mean… HCA Florida or Kern County in Bakersfield… aka the anus of California.
 
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Siggy said:
I mean… HCA Florida or Kern County in Bakersfield… aka the anus of California.
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I was actually specifically talking about the Florida ones. I'm going to point out that there are, off the top of my head, 8 HCA emergency medicine residencies in Florida and another two or three "residencies that shouldn't exist" that aren't HCA, as much as they simply are facilities not big enough to support a residency.

The four openings in Florida are 1) actually a legitimately good place (Broward. It's new but it's volume and acuity is appropriate) and 2) Brandon which is, yes, seemingly terrible and 3/4) two legitimately qualified and appropriate places that can support a residency.

So of the 8 HCA residencies the *best two* are the ones that didn't match everyone. Probably the only two HCA one that (quality of patient and acuity wise) could support a residency are the two that have openings. Except for Brandon - all the extremely questionable residencies in Florida filled right out of the match.

And that trend seems to hold up from what I see. Outside of NYC having bad residencies go empty - every other state I'm LOOKING for the **** places that I know about and I'm not seeing them. I'm seeing a mixture of below and above average places but not the *horrible* ones that should be going unmatched. It means the questionable places are actively scraping the bottom of the barrel preemptively
 
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DocEspana said:
I was actually specifically talking about the Florida ones. I'm going to point out that there are, off the top of my head, 8 HCA emergency medicine residencies in Florida and another two or three "residencies that shouldn't exist" that aren't HCA, as much as they simply are facilities not big enough to support a residency.

The four openings in Florida are 1) actually a legitimately good place (Broward. It's new but it's volume and acuity is appropriate) and 2) Brandon which is, yes, seemingly terrible and 3/4) two legitimately qualified and appropriate places that can support a residency.

So of the 8 HCA residencies the *best two* are the ones that didn't match everyone. Probably the only two HCA one that (quality of patient and acuity wise) could support a residency are the two that have openings. Except for Brandon - all the extremely questionable residencies in Florida filled right out of the match.

And that trend seems to hold up from what I see. Outside of NYC having bad residencies go empty - every other state I'm LOOKING for the **** places that I know about and I'm not seeing them. I'm seeing a mixture of below and above average places but not the *horrible* ones that should be going unmatched. It means the questionable places are actively scraping the bottom of the barrel preemptively
Click to expand...

I get it...

...hence where would you rather be... Bakersfield or coastal HCA Florida?
 
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Absolutely hilarious how EM social media/reddit/tiktok consider this match result a "win" and a "return to normalcy"

Wrong.

The gap has been filled with lower-quality candidates for whom EM is now an achievable specialty since it's no longer desirable by top-tier high-achieving medical students. Of course, nobody involved in EM (especially EM training) is going to say this publicly with their name attached.

The cynic in me thinks this is what "the system" wants since it'll be a steady stream of warm bodies to fill an ever-growing CMG footprint. A swarm of indebted EM graduates who are easily exploited and gaslit into high-stress and high-burnout clinical careers.

Two outcomes I see in the near future (3-5 years): Heavy downward pressure on wages AND an extremely competitive fellowship environment for subspecialties that allow one to escape the ED (e.g CCM, pain, HPM, etc.)
 
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HemorrhagicShock said:
Absolutely hilarious how EM social media/reddit/tiktok consider this match result a "win" and a "return to normalcy"

Wrong.

The gap has been filled with lower-quality candidates for whom EM is now an achievable specialty since it's no longer desirable by top-tier high-achieving medical students. Of course, nobody involved in EM (especially EM training) is going to say this publicly with their name attached.

The cynic in me thinks this is what "the system" wants since it'll be a steady stream of warm bodies to fill an ever-growing CMG footprint. A swarm of indebted EM graduates who are easily exploited and gaslit into high-stress and high-burnout clinical careers.

Two outcomes I see in the near future (3-5 years): Heavy downward pressure on wages AND an extremely competitive fellowship environment for subspecialties that allow one to escape the ED (e.g CCM, pain, HPM, etc.)
Click to expand...
the bottom here is 100% right. i feel for the saps who will finish in 2027 into a cess pool of a job market. i underestimated how dumb med students might be.
 
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DocEspana said:
I was actually specifically talking about the Florida ones. I'm going to point out that there are, off the top of my head, 8 HCA emergency medicine residencies in Florida and another two or three "residencies that shouldn't exist" that aren't HCA, as much as they simply are facilities not big enough to support a residency.

The four openings in Florida are 1) actually a legitimately good place (Broward. It's new but it's volume and acuity is appropriate) and 2) Brandon which is, yes, seemingly terrible and 3/4) two legitimately qualified and appropriate places that can support a residency.

So of the 8 HCA residencies the *best two* are the ones that didn't match everyone. Probably the only two HCA one that (quality of patient and acuity wise) could support a residency are the two that have openings. Except for Brandon - all the extremely questionable residencies in Florida filled right out of the match.

And that trend seems to hold up from what I see. Outside of NYC having bad residencies go empty - every other state I'm LOOKING for the **** places that I know about and I'm not seeing them. I'm seeing a mixture of below and above average places but not the *horrible* ones that should be going unmatched. It means the questionable places are actively scraping the bottom of the barrel preemptively
Click to expand...

HemorrhagicShock said:
Absolutely hilarious how EM social media/reddit/tiktok consider this match result a "win" and a "return to normalcy"

Wrong.

The gap has been filled with lower-quality candidates for whom EM is now an achievable specialty since it's no longer desirable by top-tier high-achieving medical students. Of course, nobody involved in EM (especially EM training) is going to say this publicly with their name attached.

The cynic in me thinks this is what "the system" wants since it'll be a steady stream of warm bodies to fill an ever-growing CMG footprint. A swarm of indebted EM graduates who are easily exploited and gaslit into high-stress and high-burnout clinical careers.

Two outcomes I see in the near future (3-5 years): Heavy downward pressure on wages AND an extremely competitive fellowship environment for subspecialties that allow one to escape the ED (e.g CCM, pain, HPM, etc.)
Click to expand...

Not just a steady stream of warm bodies, but a steady stream of warm bodies that would otherwise be making ≈$30,000 a year in their home country and will be thrilled to make $125 / hour in the US
 
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Michigan appears to be a bloodbath
 
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EctopicFetus said:
the bottom here is 100% right. i feel for the saps who will finish in 2027 into a cess pool of a job market. i underestimated how dumb med students might be.
Click to expand...

I think a HUGE part of the issue is that medical students aren't necessarily dumb, they're just being LIED to when it comes to emergency medicine.

Often the first time they get to do anything meaningful clinically is on an EM rotation (due to low staffing and acceptance of lower quality approach e.g. "Here medical student, go do your first laceration repair on this Medicaid patient, figure it out and call me if you need help")

They're nearly 100% shielded from the WORST parts of EM (metrics, hostile consultants, patient satisfaction, documentation burden)

They're young and don't FEEL the long-term health and mental effects of circadian switches on a few months of audition/elective rotations.

Agreed though that they're saps in the sense that they're falling for sales tactics sold to them by residencies who have their own agendas without having access to mentorship that can show students the big picture.

Sad state of affairs
 
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At this moment I'm not even thinking in terms of the impact on the career and the market.... I'm thinking about how totally piss poor some of my older colleagues practice medicine (sorry. But only some of them). And I don't even mean the fact that they are out of date on their literature. I mean that some of them are just.... Like.... Not exactly *the best* physicians but because of momentum, grandfathering, or just different education standards they are still in emergency medicine while being noticeably less academic and rigorous in their thinking. Again not all of them ... But some of them.

And now I'm left wondering if we are about to get a wave of people 3-4 years from now hitting the market who are just academically not of the quality we need. So much pride was taken around the time that I was in residency that emergency medicine was not going to be the dumb overpaid triage nurses that we had been stigmatized as. We were going to be the people who knew the basics (and intermediates) of everyone else's field better than them and can school them on anything except niche specifics of their fields. Now I'm afraid that we are going to fully live up to the idiots with lyringoscopes stereotype. And I don't think a bunch of people with questionable education centers and below snuff starting characteristics are the wave of the future I want to have replacing my generation eventually.
 
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any NYC programs have openings?
 
HemorrhagicShock said:
I think a HUGE part of the issue is that medical students aren't necessarily dumb, they're just being LIED to when it comes to emergency medicine.

Often the first time they get to do anything meaningful clinically is on an EM rotation (due to low staffing and acceptance of lower quality approach e.g. "Here medical student, go do your first laceration repair on this Medicaid patient, figure it out and call me if you need help")

They're nearly 100% shielded from the WORST parts of EM (metrics, hostile consultants, patient satisfaction, documentation burden)

They're young and don't FEEL the long-term health and mental effects of circadian switches on a few months of audition/elective rotations.

Agreed though that they're saps in the sense that they're falling for sales tactics sold to them by residencies who have their own agendas without having access to mentorship that can show students the big picture.

Sad state of affairs
Click to expand...

Here's the thing though:

There's soooo much information out there now. So much more so than 10 or even 5 years ago.
 
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calvinhobbes said:
any NYC programs have openings?
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Seven programs either in New York City or extremely close to the formal borders of New York City have openings. I don't know much about NUMC or Northwell as EM programs, but I know they have enough volume and variety of illness AS HOSPITALS to be capable, at least assuming nothing majorly changed in the last few years (and NUMC has a ton of residencies in all sorts of fields that bring in interesting acuity).

I'm not in a position to give endorsements for any of the other five, though some of them definitely give me pause and concern that they exist at all.
 
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Aren’t they constantly threatening to shut down NUMC lol. Poor NUMC, so mismanaged
 
DocEspana said:
Seven programs either in New York City or extremely close to the formal borders of New York City have openings. I don't know much about NUMC or Northwell as EM programs, but I know they have enough volume and variety of illness AS HOSPITALS to be capable, at least assuming nothing majorly changed in the last few years (and NUMC has a ton of residencies in all sorts of fields that bring in interesting acuity).

I'm not in a position to give endorsements for any of the other five, though some of them definitely give me pause and concern that they exist at all.
Click to expand...
The Zucker program that didn't fill isn't Northshore/LIJ, it's South Shore, which is a 300 bed hospital on central Long Island that Northwell bought a few years ago, though it is a level 2 trauma and has the usual STEMI/stroke stuff.

As far as other programs, I've heard that St Barnabas will train you be an OK EM physician while simultaneously training you to be an excellent nurse and patient transporter.
 
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InternistDO said:
The Zucker program that didn't fill isn't Northshore/LIJ, it's South Shore, which is a 300 bed hospital on central Long Island that Northwell bought a few years ago, though it is a level 2 trauma and has the usual STEMI/stroke stuff.

As far as other programs, I've heard that St Barnabas will train you be an OK EM physician while simultaneously training you to be an excellent nurse and patient transporter.
Click to expand...
I visited South Shore hospital once because I was a med student and one of the specialties that I was at did cross coverage at South Shore. Incredibly long drive to get out there first off. Secondly, that emergency room was so terrifying that I still remember it to this day. And I have been in a lot of the famous Brooklyn emergency rooms from hell, they don't phase me.

Obviously I did not read it close enough and realize that that was South Shore. Would not have dared to say anything nice about South Shore.
 
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DocEspana said:
I visited South Shore hospital once because I was a med student and one of the specialties that I was at did cross coverage at South Shore. Incredibly long drive to get out there first off. Secondly, that emergency room was so terrifying that I still remember it to this day. And I have been in a lot of the famous Brooklyn emergency rooms from hell, they don't phase me.

Obviously I did not read it close enough and realize that that was South Shore. Would not have dared to say anything nice about South Shore.
Click to expand...
Whereas I found South Shore to be rather benign.
 
DocEspana said:
At this moment I'm not even thinking in terms of the impact on the career and the market.... I'm thinking about how totally piss poor some of my older colleagues practice medicine (sorry. But only some of them). And I don't even mean the fact that they are out of date on their literature. I mean that some of them are just.... Like.... Not exactly *the best* physicians but because of momentum, grandfathering, or just different education standards they are still in emergency medicine while being noticeably less academic and rigorous in their thinking. Again not all of them ... But some of them.

And now I'm left wondering if we are about to get a wave of people 3-4 years from now hitting the market who are just academically not of the quality we need. So much pride was taken around the time that I was in residency that emergency medicine was not going to be the dumb overpaid triage nurses that we had been stigmatized as. We were going to be the people who knew the basics (and intermediates) of everyone else's field better than them and can school them on anything except niche specifics of their fields. Now I'm afraid that we are going to fully live up to the idiots with lyringoscopes stereotype. And I don't think a bunch of people with questionable education centers and below snuff starting characteristics are the wave of the future I want to have replacing my generation eventually.
Click to expand...
I will say that I see this already. There are some horrifically bad new grads. Like I legit wonder if they didn’t pay attention or no one cared enough to teach them. I also echo the older doc part. I think it comes down to numbers of these people. Most of the new grads are decent. Some are stellar. Some of the old guys are fine. The questionable ones I worked with are retired or are on the cusp.

Our reputation is gonna go in the toilet but I can’t say it doesn’t belong there.
 
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WhatJobDoIPick said:
Here's the thing though:

There's soooo much information out there now. So much more so than 10 or even 5 years ago.
Click to expand...

True tons of resources. When I joined SDN in 2002(!), I learned about the "hot" job market here in the field I eventually chose. Heard a lot of about this during med school from other med students, residents, and attendings. I would imagine that at some point, one would at least get some sense that there were issues with a particular field but who knows...and on a side note, no one in 2002 told me about the cyclical nature of the job market and how some specialties go through a "golden age" which can distort reality 😖🙃
 
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WhatJobDoIPick said:
Here's the thing though:

There's soooo much information out there now. So much more so than 10 or even 5 years ago.
Click to expand...

There may be more information, but you still have to be willing to entertain the conclusion(s), even if they aren't palatable.

People love their echo chambers.
 
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