Are there too Many new graduates going to EM now?

[LanceArmstrong]

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I really don't know the answer to this question, but I get the impression that half of the last two year's graduates seemed to have went into ER. I know EM was very competetive in the mid-late 90's and now is somewhat less so but are we heading for a surplus of emergency room docs? Certainly on the flip side some programs did go unfilled this year, and there are ER's out there that hire FP's or internists to do EM... So what is your opinoin on this issue? Of course no one has a crystal ball, but if you have looked into this issue please share your comments.

 

[LanceArmstrong]

I really don't know the answer to this question, but I get the impression that half of the last two year's graduates seemed to have went into ER. I know EM was very competetive in the mid-late 90's and now is somewhat less so but are we heading for a surplus of emergency room docs? Certainly on the flip side some programs did go unfilled this year, and there are ER's out there that hire FP's or internists to do EM... So what is your opinoin on this issue? Of course no one has a crystal ball, but if you have looked into this issue please share your comments.

P.s. this year apparently all programs filled after the scramble, so EM is getting more competetive again it seems.

 

[bulgethetwine]

P.s. this year apparently all programs filled after the scramble, so EM is getting more competetive again it seems.

This topic has been discussed before (do a search with the SDN engine) but it is always a dynamic topic and a revisit is never without new insights.

One thing I seized on was your observation that many departments hire FPs and internists. This is correct, but increasingly less common. Many departments have, or are in the process of, transitioning to a strict emergency physician BC/BE policy (BC/BE = board certified/board eligible). Nearly all academic programs are like this. Most places that hire FPs and internists do so out of necessity due to too few qualified applicants; but some certainly do so out of deference to the dollar (an FP is, in general, cheaper).

As Emergency medicine as a specialty has evolved (remember, it is still a fairly recent phenomenon, and many still consider it to be in the nascent stages) so, too, has the reputation of its practitioners with the gradual acceptance of the special tools and skill sets that an EP brings to the table compared to, say, an FP (the latter, of course, have their own unique skill set -- different, not better or worse). This helps explain the trend in the prevoius paragraph.

Another important issue is that we are, as EPs, more involved in the front lines of health care than ever before. This means primary care is a large component, for better or worse. For that reason, many postulate that the need and opportunity for emergency physicians is likely to continue to grow over the next two decades.

 

[southerndoc]

If you read the literature, most emergency medicine societies project a shortage of emergency physicians through 2020.

A recent article in the ACEP newsletter highlighted this fact. Many states have below average levels of emergency physicians staffing ED's.

I hope the proposed revisions in Medicare Part A won't significantly affect our incomes, and thereby affect the number of people entering into emergency medicine.

 

[LanceArmstrong]

I hope the proposed revisions in Medicare Part A won't significantly affect our incomes, and thereby affect the number of people entering into emergency medicine.

What exactly is the revision?

 

[OSUdoc08]

I really don't know the answer to this question, but I get the impression that half of the last two year's graduates seemed to have went into ER. I know EM was very competetive in the mid-late 90's and now is somewhat less so but are we heading for a surplus of emergency room docs? Certainly on the flip side some programs did go unfilled this year, and there are ER's out there that hire FP's or internists to do EM... So what is your opinoin on this issue? Of course no one has a crystal ball, but if you have looked into this issue please share your comments.

Considering the fact that a large number of emergency departments are manned by non-board certified EM physicians (family practitioners, internists, etc.) and that many others are covered by moonlighting EM residents, it is clear that it is not possible to even fill emergency departments at the current time. With the amount of new hospitals (ERs) that are opening, I doubt we could ever catch up to the growth rate. This is without adding on the huge increase in patient population as the baby boomers age.

 

[EMApplicant]

Many states have below average levels of emergency physicians staffing ED's.

When you consider what an average is, mathematically speaking, it is not surprising that there would be many states that are either above it or below it.

 

[Hercules]

When you consider what an average is, mathematically speaking, it is not surprising that there would be many states that are either above it or below it.

Quite True 😉 I think the point was that in some states you have lots of non-boarded physicians practicing EM. My state (Alabama) only has 1 in 6 of its physicians in the ED actually boarded in EM.

 

[LanceArmstrong]

recent article in the ACEP newsletter highlighted this fact. Many states have below average levels of emergency physicians staffing ED's.
.

Yeah I read as many as 50% of the states have below average levels of emergency physicians staffing the ED 😀

 

[LanceArmstrong]

Considering the fact that a large number of emergency departments are manned by non-board certified EM physicians (family practitioners, internists, etc.) and that many others are covered by moonlighting EM residents, it is clear that it is not possible to even fill emergency departments at the current time. With the amount of new hospitals (ERs) that are opening, I doubt we could ever catch up to the growth rate. This is without adding on the huge increase in patient population as the baby boomers age.

Are there in fact many new hospitals opening? Doesnt seem likely with the reimbursement cuts and all...

I guess all this fits under the generalist vs. specialist thing that is now happening in american medicine where in heavily served urban areas insured people go to an ENT for a nosebleed or to GI for heartburn, while in uderserved areas FP, IM's and GS provide virtually all care - if not provided by PA's, LNP's, CCRNA's, etc.

 

[docB]

I really don't know the answer to this question, but I get the impression that half of the last two year's graduates seemed to have went into ER. I know EM was very competetive in the mid-late 90's and now is somewhat less so but are we heading for a surplus of emergency room docs? Certainly on the flip side some programs did go unfilled this year, and there are ER's out there that hire FP's or internists to do EM... So what is your opinoin on this issue? Of course no one has a crystal ball, but if you have looked into this issue please share your comments.

EmCare (which is the huge EM staffing group that I work for) is actually projecting a worsening EP shortage over the next 20 years as the docs in the boomer generation start to retire. With those retirements and the usual attrition the shortfall can't be replaced by graduating residents. In fact the current EmCare and ACEP thinking is that our biggest danger as a specialty is that if we can't staff the needed positions with BC EPs the internists and FPs will have a greater incentive to move in on EM jobs.

 

[LanceArmstrong]

our biggest danger as a specialty ... internists and FPs will have a greater incentive to move in on EM jobs.

Are these generalists a threat to EM's? What about PA's, LPN's. Is their training equivalent? I think we need to consider this, because American society like it or not is gradually heading towards more "streamlined" medicine - see Medicare cuts...

 

[docB]

Are these generalists a threat to EM's? What about PA's, LPN's. Is their training equivalent? I think we need to consider this, because American society like it or not is gradually heading towards more "streamlined" medicine - see Medicare cuts...

Yeah, I wasn't really commenting on the midlevel issue. As for physicians EM has more chance of being overrun by non BC EM docs than of overpopulating with BC EM people. At least that's the thought of EmCare and ACEP.

 

[Koko]

Yeah, I wasn't really commenting on the midlevel issue. As for physicians EM has more chance of being overrun by non BC EM docs than of overpopulating with BC EM people. At least that's the thought of EmCare and ACEP.

My understanding is that medical centers are by and large looking specifically for BC EM docs, so the market/opportunities for the non BC providors is drying up, save for the more rural hospitals. If this is true, then over time the non BC docs will not "overrun" the ED, but be forced out. I would think that legal liability of non BC docs in the ED (and therefore hospitals that employ these docs) would also continue to grow, providing more pressure on hospitals to hire BC EM docs over non BC docs.

 

[docB]

My understanding is that medical centers are by and large looking specifically for BC EM docs, so the market/opportunities for the non BC providors is drying up, save for the more rural hospitals. If this is true, then over time the non BC docs will not "overrun" the ED, but be forced out. I would think that legal liability of non BC docs in the ED (and therefore hospitals that employ these docs) would also continue to grow, providing more pressure on hospitals to hire BC EM docs over non BC docs.

Right but that's the current situation. We (BC EM docs) have enough numbers to fill the urban markets and a lot of the rural markets. I'm saying that the numbers in 10 - 20 years are concerning. If our numbers drop proportionally and we can't fill the needed positions someone will. The worry is that once other groups get their feet in the door we will be the worse for it.

 

[Koko]

Right but that's the current situation. We (BC EM docs) have enough numbers to fill the urban markets and a lot of the rural markets. I'm saying that the numbers in 10 - 20 years are concerning. If our numbers drop proportionally and we can't fill the needed positions someone will. The worry is that once other groups get their feet in the door we will be the worse for it.

I still think that the potential legal liability will pressure both non BC docs from jumping in the sand box in large numbers and hospitals from inviting them in. Malpractice insurance will correspondingly increase. So while they may serve as a stop gap, I can't see them posing a real, long term threat, for lack of a better word.

 

[docB]

So while they may serve as a stop gap, I can't see them posing a real, long term threat, for lack of a better word.

You and ACEP and EmCare disagree.

 

[Koko]

You and ACEP and EmCare disagree.

I'm not pretending to have all the facts on this, I'm skeptical of their position for the reasons I mentioned and was curious to discuss.

 

[docB]

I'm not pretending to have all the facts on this, I'm skeptical of their position for the reasons I mentioned and was curious to discuss.

You're extrapolating the current situation into a hypothetical future. Yes, right now, insurance is higher for non BC EM docs. That is because there are almost enough BC EM docs to go around and the insurers are trying to give a recruitment incentive. Now, the future envisioned by ACEP is one where there is a much more serious shortage of BC EM docs and many hospitals will have no chance, no matter what the cost, of filling those spots with BC EM docs. The insurance issue may exert pressure to try to get BC EM docs but if they don't exist then they can't fill the spots. Someone will fill those spots. The concern is that it could be IM and FP and whoever else is available.