Are we tying our nooses w/ residency expansion?

[sum dude]

Med School Announces New Emergency Medicine Residency, Seeks Applicants Now - UCF News - University of Central Florida Articles - Orlando, FL News
https://today.ucf.edu/med-school-announces-new-emergency-medicine-residency-seeks-applicants-now/
Florida has multiple new EM residencies planned for the next few years. This would normally be good news...however...they are at almost all at HCA hospitals, the many of which I would say have no business opening EM residencies (eg Ocala Regional which has 200 beds and is in a small city where majority of referrals get swallowed up by UF-Shands 30 minutes up the road). Right now, they are planning for 140 new spots in Florida, and they're all at new, many unproven programs (some applications for residencies have blank spots listed under faculty). I recently found out they are sponsored by HCA getting FL Medicaid/matching National grant, for get this, "improving primary care." Someone has managed to get EM listed as an at need, primary care specialty to get this funding.

What do you guys think? My personal opinion is that this is a ploy (albeit smart one) by HCA to expand the physician base and recruit their own grads. I think this will dilute both the quality of grads in Florida, as well as push downward pressure on compensation (if you added 140 EM physicians to your state every year, your salaries are going to go down.) Plus it should be easy for HCA/Envision to recruit these docs. Further concern is that some of the places are not equipped, neither volume-wise nor leadership wise, to handle residencies (does Gainesville/Ocala, FL really need 3 EM residencies when Miami has 2?)

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[RustedFox]

I'm on board with you. I presently live and work south of Tampa.

The Ocala/Gainesville area doesn't have what it takes to have 3 EM residencies.

I also hope HCA dies in a fire.

 

[GeneralVeers]

We aren't doing it alone. The government, insurance companies, hospitals, and CMGs all want a bigger supply of EPs on the market so they can pay us less. Unfortunately in the name of "teaching" EPs seem only too willing to take academic jobs at expanded residency programs.

 

[Vandalia]

Well, the need is not going away. So I would say that we are pretty much better off as a specialty having trained EM physicians rather than Family Med or old surgeons (thinking of another thread) working in our EDs. Not to mention mid-levels.

It also isn't like we would benefit much from the reduced supply since most of us seem to value limiting work and reducing burnout over more money. If I offered you $1M more a year, would you work an extra three shifts a week? Some medical students will probably say they would jump at that, but my guess is that the veterans here will say "no way in ****!"

You don't want a tremendous oversupply of EM physicians, but you also don't want an under-supply, or you lose the specialty. They aren't going to close the EDs between midnight and 6 am.

 

[Perrotfish]

It also isn't like we would benefit much from the reduced supply since most of us seem to value limiting work and reducing burnout over more money. If I offered you $1M more a year, would you work an extra three shifts a week? Some medical students will probably say they would jump at that, but my guess is that the veterans here will say "no way in ****!"
.

It doesn't work like that. The more supply there is, the more leverage your employer has, and the more your hours you need to be willing to put in for them to hire you at all. Perversely, employees only get the opportunity to limit their workload when there is no one to take their place.

 

[sfwtboy]

I feel like in medical school there were always people advocating for the ACGME to expand residencies and that there weren't enough spots for applicants with all the new med schools popping up (albeit this is for all specialties). Now I'm hearing the opposite. I can't say I know the market that well but it does seem like we've had quite a few new residencies pop up in the past 5 years. Has this happened before? Did it effect the market?

 

[MSmentor018]

every large scale business tries to economically control us, confounded with the quagmire of insane metrics, dumped into a pandora's box of EMR/billing practices, now by cranking out more programs it takes away one of the few leverages we have left, they're killing us within. well played motherf!@#ers, well played

 

[southerndoc]

GV is spot on. This is a plot to increase supply to reduce demand and therefore reduce cost of emergency physicians. Insurance companies realize that EP's bill more than most providers and it's an easy way to save them money since there are so many ED visits. If you think this is a conspiracy theorist view, then you have no idea what the insurance companies will do to keep their money.

 

[BigRedBeta]

Expansion in and of itself probably isn't the real problem. What becomes the issue is that those grads won't evenly distribute themselves (not their fault either). So you end up with "enough" EM physicians, but significant chunks of the country being underserved. As EM continues to advance as a specialty and y'all get more conscientious about shops being covered by non-EM trained people, that problem only gets worse. Then the economic complaints get more pronounced as the glut of ED attendings in more desireable locations depresses wages.

For HCA - that's a good thing for them, so makes sense why they're getting into the game.

Unfortunately, short of required years in Pig's Knuckle, Montana, not sure how you fix that problem. It's a similar thing that happens in general pediatrics - you hear all these stories about Gen Peds providers in Northern California, making 70k. But there's obviously a glut of pediatricians there, they took a 3 day a week job with no nursery or overnight call coverage and then are bitching that they can't afford to live in one of the highest cost of living areas in the world.

 

[EctopicFetus]

Make no mistake this is bad for EPs. You know those stories of docs working for $500/hr doing Locums for Emcare. That will go away. Oddly, Florida has no major shortage so you will either see folks traveling or having them drive down what they pay like they do in Hawaii.

Not a great time to just be starting your EM career. To be fair the shortage and difficulty in obtaining a license has been really good for the Texas docs. More docs means if you work for a CMG less money.

If you own your own practice as an SDG or FSED then you are fine. Makes no difference.

 

[gro2001]

On the other hand, if we don't train enough EPs, that will be a further incentive for the expansion of midlevel and non BC/BE MD opportunities. We either come closer to meeting the demand for EPs, or in a few years we will be in the same spot as anesthesia, wailing about the specialty being taken over by people we have little to no control over.

 

[Brigade4Radiant]

On the other hand, if we don't train enough EPs, that will be a further incentive for the expansion of midlevel and non BC/BE MD opportunities. We either come closer to meeting the demand for EPs, or in a few years we will be in the same spot as anesthesia, wailing about the specialty being taken over by people we have little to no control over.

This is true shortage is a double edge sword. What we need to do is lobby or infiltrate CMG where we get to retain some piece of the pie.

 

[alpinism]

My favorite part about the new Gainesville program is that they're currently sending their residents to Ocala for their trauma exposure where they work at level 2 trauma center that sees 40K patients per year. Better yet is the fact that the residents get to make the 80 mile round trip drive every day while working 80 hrs per week.

 

[bravotwozero]

There was already a program I. Gainesville...they started another one? Yeesh.


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[EctopicFetus]

On the other hand, if we don't train enough EPs, that will be a further incentive for the expansion of midlevel and non BC/BE MD opportunities. We either come closer to meeting the demand for EPs, or in a few years we will be in the same spot as anesthesia, wailing about the specialty being taken over by people we have little to no control over.

Not if you own your business.

 

[jupiterianvibe]

See pathology.

We have training programs in hospitals that don't even have oncology departments. Residents at these programs will have ZERO exposure to real-world pathology practice.

The expansion of pathology programs was part of the long-game by the lab lobby, which has also essentially bought our so-called professional organization, the CAP. So we have been sold down the river entirely, from all sides. Our field is nothing now.

Don't worry so much about midlevels. An ED is not the same as urgent care. The liability on midlevels staffing the ED is quite high, and all it would take is one huge lawsuit against a staffing company to put an end to that practice.

Your reps have to stop this ASAP. If they don't, then I'd wager they're profiting from it somehow.

 

[deleted109597]

My favorite part about the new Gainesville program is that they're currently sending their residents to Ocala for their trauma exposure where they work at level 2 trauma center that sees 40K patients per year. Better yet is the fact that the residents get to make the 80 mile round trip drive every day while working 80 hrs per week.

Ouch. No housing provided? At least Jax provides housing for the students.

 

[gro2001]

See pathology.

We have training programs in hospitals that don't even have oncology departments. Residents at these programs will have ZERO exposure to real-world pathology practice.

The expansion of pathology programs was part of the long-game by the lab lobby, which has also essentially bought our so-called professional organization, the CAP. So we have been sold down the river entirely, from all sides. Our field is nothing now.

Don't worry so much about midlevels. An ED is not the same as urgent care. The liability on midlevels staffing the ED is quite high, and all it would take is one huge lawsuit against a staffing company to put an end to that practice.

Your reps have to stop this ASAP. If they don't, then I'd wager they're profiting from it somehow.

I am not worried about being replaced by a midlevel. I don't think that's the future. I am worried about the model moving from MD being expected to see 2.5-3 patients/hr to MD supervising 5 midlevels, each seeing 1.5-2 patients per hour, signing off on their charts, without really being able to see each patient themselves or having time to see patients on their own. I want to see patients, not just live vicariously through others. Would it be an apocalyptic future? Not really. But it seems worse than what we have now.

 

[Birdstrike]

Med School Announces New Emergency Medicine Residency, Seeks Applicants Now - UCF News - University of Central Florida Articles - Orlando, FL News
Florida has multiple new EM residencies planned for the next few years. This would normally be good news...however...they are at almost all at HCA hospitals, the many of which I would say have no business opening EM residencies (eg Ocala Regional which has 200 beds and is in a small city where majority of referrals get swallowed up by UF-Shands 30 minutes up the road). Right now, they are planning for 140 new spots in Florida, and they're all at new, many unproven programs (some applications for residencies have blank spots listed under faculty). I recently found out they are sponsored by HCA getting FL Medicaid/matching National grant, for get this, "improving primary care." Someone has managed to get EM listed as an at need, primary care specialty to get this funding.

What do you guys think? My personal opinion is that this is a ploy (albeit smart one) by HCA to expand the physician base and recruit their own grads. I think this will dilute both the quality of grads in Florida, as well as push downward pressure on compensation (if you added 140 EM physicians to your state every year, your salaries are going to go down.) Plus it should be easy for HCA/Envision to recruit these docs. Further concern is that some of the places are not equipped, neither volume-wise nor leadership wise, to handle residencies (does Gainesville/Ocala, FL really need 3 EM residencies when Miami has 2?)

It makes sense to look at this from a short term vs long term perspective, and also from an Emergency Physicians vs Hospital/Staffing-Group perspective.

From an Emergency Physicians perspective, in the short term, the increased supply of BC/BE Emergency Physicians helps. You may find it easier to get your department more fully staffed and may reduce pressure to always work more shifts than is good for your mental health.

In the long term, I agree, that if the trend is not kept in check, it could end up leading to a glut in EPs. With the shortage that there is now, combined with the fact that there seems to be a never ending and ever expanding supply of ED patients, that reality may be further off than it seems, but it is definitely something to think about.

From the short term perspective of the hospitals opening these programs, it's good because of the funding they get to start these programs. It's profitable. And if it wasn't, you can be sure as hell that HCA wouldn't be doing it.

From the long term perspective, you are absolutely correct, that they're trying to increase the supply of physicians to make it easier to recruit, but also to drive down physician labor costs. You bet your a-- they are. And this is what concerns me. Even though solving the EP physician shortage has the potential to make EPs live better from the standpoint of wellness with increased staffing help, you absolutely can NOT rely on companies like HCA to pass that along to EPs. Because they will not, if they can help it. If they have the ability to squeeze every little nanogram of benefit out of the increased staffing to benefit themselves and no one else, they will.

As a part of a physician owned, independent group you may have a better chance of passing some of benefits of the increases worker supply along to yourselves to increase coverage, wellness, and job satisfaction. But hospitals and staffing groups, particularly for profit hospitals will not. They will look at increasing they're own profits, period. If they can get away with paying their docs $1 per hour to see twice as many patients, you can bet your last dollar they will.

But keep in mind, often the fears of these trends is worse than the reality. I think EPs will always be in demand because it's tough work and there will always be a lot of people demanding the service. But it is possible that the very high pay rates to cover desperately understaffed EDs may not be sustainable.

 

[Old_Mil]

There is an issue here that goes beyond for profit entities attempting to increase the available pool of boarded EPs to drive down salaries.

An additional reason why a for profit entity can seek to establish an emergency medicine residency is to increase staffing at a site at a low cost. An EM resident makes 1/3rd to 1/2 as much as an Emergency PA.

In a normal academic setting, you've collected a staff of people who have made a conscious decision to get into and stay in academic medicine knowing that training medical students and residents comes with the territory.

When you create an EM residency out of thin air due out of economic concerns, you are taking community physicians and turning them into academic attendings overnight. Speaking from personal experience that transition isn't always a smooth one.

 

[theSmurfette]

Ouch. No housing provided? At least Jax provides housing for the students.

Right now, the interns basically live in the call rooms when they’re on trauma. I think I remember being told that they’re working on an apartment of some type.


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[Brahnold Bloodaxe]

I've been concerned about this ever since I joined this forum nearly 2 years ago. I was somewhat reassured by several attendings on this board insisting that such a huge shortage of EPs existed that oversupply would not be an issue on the horizon, but I remained skeptical because of the sheer volume of residents being minted each year. It's now well over 2000 and will likely exceed 2500 by the time I would be a PGY1 in 2020. By comparison, when most of the veterans of this board were in training, the number of spots was around 1500 or fewer.

Lo and behold, if you check the "Texas" thread it seems a marked tightening of the job market across much of the state has occurred within just the past year or so. Texas has long been the EM mecca with the largest shortages creating the highest hourly rates. If the Texas market is becoming saturated, doesn't that bode ill for the other regions of the country which traditionally have been better staffed to begin with? Sure, you can still easily find work in BFE, but let's not kid ourselves: the vast majority of ED staffing needs is in cities. Once you saturate locations that constitute 85% of the demand, how is the remaining 15% going to absorb 2000+ graduates a year? There is a finite number of EDs and ED shifts out there, once they're filled and you keep pumping out thousands of new docs every year it's going to be a massacre since they can't exactly hang up a shingle like primary care can. Once the shortage turns into a glut, hourly rates will fall and docs who were previously fat and happy working 12 shifts a month will be looking for more shifts to make up the difference to maintain income, exacerbating the oversupply further. I'm not even going to get into the fact that midlevel utilization is exploding and is certain to compound oversupply issues further.

For what it's worth, here's a Journal of Emergency Medicine study that arrives at more or less the same conclusion:
The Emergency Medicine Workforce: Profile and Projections. - PubMed - NCBI

 

[Dre8]

Med School Announces New Emergency Medicine Residency, Seeks Applicants Now - UCF News - University of Central Florida Articles - Orlando, FL News
Florida has multiple new EM residencies planned for the next few years. This would normally be good news...however...they are at almost all at HCA hospitals, the many of which I would say have no business opening EM residencies (eg Ocala Regional which has 200 beds and is in a small city where majority of referrals get swallowed up by UF-Shands 30 minutes up the road). Right now, they are planning for 140 new spots in Florida, and they're all at new, many unproven programs (some applications for residencies have blank spots listed under faculty). I recently found out they are sponsored by HCA getting FL Medicaid/matching National grant, for get this, "improving primary care." Someone has managed to get EM listed as an at need, primary care specialty to get this funding.

What do you guys think? My personal opinion is that this is a ploy (albeit smart one) by HCA to expand the physician base and recruit their own grads. I think this will dilute both the quality of grads in Florida, as well as push downward pressure on compensation (if you added 140 EM physicians to your state every year, your salaries are going to go down.) Plus it should be easy for HCA/Envision to recruit these docs. Further concern is that some of the places are not equipped, neither volume-wise nor leadership wise, to handle residencies (does Gainesville/Ocala, FL really need 3 EM residencies when Miami has 2?)

Well ED visits are increasing and the population is getting older, so I think that mitigates some of the problems with increased MDs.

And now for the zinger... EM is increasing in popularity with women, sometimes because of the ability to go part time. So that mitigates some of that damage, too. Fire away at me

 

[GeneralVeers]

This is why I have predicted we have 2-5 years left to make decent money before our salaries crater. My Australia exit plan is looking better every day.

 

[s109442]

This is why I have predicted we have 2-5 years left to make decent money before our salaries crater. My Australia exit plan is looking better every day.

Spectacular idea

 

[s109442]

Wreck of the Yongala - ridiculous

 

[Brahnold Bloodaxe]

This is why I have predicted we have 2-5 years left to make decent money before our salaries crater. My Australia exit plan is looking better every day.

Ironically, 5 years is exactly how long it would take me to become an EM attending. Looks like I should redouble my efforts in making sure I'm competitive for a surgical subspecialty. The whole medicine ship is listing forward, but I've already bought my ticket and boarded, so the only thing I can do at this point is make my way to the stern

 

[RustedFox]

Ironically, 5 years is exactly how long it would take me to become an EM attending. Looks like I should redouble my efforts in making sure I'm competitive for a surgical subspecialty. The whole medicine ship is listing forward, but I've already bought my ticket and boarded, so the only thing I can do at this point is make my way to the stern

I am not as bleak as Veers in my predictions. Doesn't mean I like him any less.

They're building two new hospitals within a 30 mile drive from my home THIS YEAR.

Our population (and especially our senior citizen population) is going to keep increasing steadily.

At my main job site, we just hired two new docs because our volume is up, up, up.

- and I still get calls from recruiters weekly asking me to pick up work in sites all over Florida.

 

[Fox800]

I am not as bleak as Veers in my predictions. Doesn't mean I like him any less.

They're building two new hospitals within a 30 mile drive from my home THIS YEAR.

Our population (and especially our senior citizen population) is going to keep increasing steadily.

At my main job site, we just hired two new docs because our volume is up, up, up.

- and I still get calls from recruiters weekly asking me to pick up work in sites all over Florida.

And ~50% of primary care is now delivered in the emergency department.

 

[Janders]

wait wait wait

HCA is opening a new residency in Gainesville (not at the U Florida hospitals) AND a separate one in Ocala?

Holy moly have things changed since I left town...

 

[RustedFox]

And ~50% of primary care is now delivered in the emergency department.

I saw that article, too.

I'm not sure whether you want to be sincere or snarky; but either really works for the sake of discussion.

I feel like a large capacity of my day is doing primary care; largely in part because I hear the phrase "my doctor told me to go to the ER" or "the UC doctor told me to go to the ER" in situations where simple common sense and using a clinical decision-making rule could have obviated the visit.

This sheds light onto (one of the) real underlying problem(s) in the health system. Nobody can "get in to see their family care doctor" in what now... 4-6 weeks?

What is it going to take to grow family care here in this nation?

I think that at least some of the part is recruiting good talent in terms of students. I hate that I click thru the EMR on the patient's name... see the patient's PMD, and think to myself: "oh, great - my cat knows more medicine than your PMD does." That happens way more often that I want it to. My wife and closest local friends know that I have a "blacklist" of PMDs (and some surgeons and OBGYNs) that I straight up won't let them go to.

 

[Frazier]

Pick EM because you like the responsibilities and duties inherent to being an EM doc.
Don't choose it on the promise of making 350k for 12 shifts a month.
Some things, such as $$$, are certain to change and be volatile.
Other things will stay constant -- shift work schedule, when you're off you're off, no pagers, do good work everyday, diverse pathology, diverse patient population, procedures mixed in.

Choosing to become a surgeon for more money sounds like a pretty bad idea. Your $/hr will pretty much always be lower.

 

[RustedFox]

wait wait wait

HCA is opening a new residency in Gainesville (not at the U Florida hospitals) AND a separate one in Ocala?

Holy moly have things changed since I left town...

I predict these new residencies will come under lots of scrutiny and perhaps "not make it".

 

[Janders]

I predict these new residencies will come under lots of scrutiny and perhaps "not make it".

I can't say I know anything about the current happenings down there-- but when I left the UF Gville residency was the new kid on the block, I would have been the 2nd class if I stayed, IIRC. Makes me feel old to think two new residencies are opening in the area...

 

[RustedFox]

I can't say I know anything about the current happenings down there-- but when I left the UF Gville residency was the new kid on the block, I would have been the 2nd class if I stayed, IIRC. Makes me feel old to think two new residencies are opening in the area...

I recreate in that area all the time. There's not enough pathology for three residencies.

Similarly, in my beloved home state of PA, I would "delete" 3 or 4 of the "new" residencies that are either popping up, or "new since the MD/DO merger".

Its dangerous what they're doing. I recommend increasing class size at existing programs over establishing new programs in wherever.

 

[hundreddaysoff]

Ironically, 5 years is exactly how long it would take me to become an EM attending. Looks like I should redouble my efforts in making sure I'm competitive for a surgical subspecialty. The whole medicine ship is listing forward, but I've already bought my ticket and boarded, so the only thing I can do at this point is make my way to the stern

Have you thought about specialties with permanently low supply relative to demand, like derm or psych?

As someone else said, one problem w/ surgical subspecialties is that $/h is very much less vs EM... that's what you trade for intentionally low labor supply. Of course, the other problem is that you have a greater chance of not matching, getting stuck in the prelim intern trap, or not finishing residency vs the medical specialties, for any one of various ridiculous reasons. AFAICT, that's a major way in which the surgeons regulate their own supply.

 

[Technorino]

Question. Would going to one of these HCA residencies hinder chances of finding a job? Why are people so against this company? For pure training purposes, are there any negatives to HCA? Or are ya'll just on the HCA bandwagon because they are evil etc etc

 

[EctopicFetus]

Question. Would going to one of these HCA residencies hinder chances of finding a job? Why are people so against this company? For pure training purposes, are there any negatives to HCA? Or are ya'll just on the HCA bandwagon because they are evil etc etc

I would advise you research HCA and Emcare and the beyond shady things they do not the least of which is the fee splitting agreement they have entered into together.

HCA is for profit and as such thats the primary focus of their business.

Some things to consider: as the population ages they will utilize the ED more. However, there are tons of resources being put forth to mitigate this. That being said anything that increases EP supply is bad. Putting out extra crappy EPS from substandard programs run by the 2 most evil non pharma non insurance entities in medicine is real bad.

 

[TheComebacKid]

I guess my question is, why is EM following the same path as anesthesia? Why do certain specialties follow the same path of over saturation, while other specialties say... urology, stay relevant and withstand the test of time for decades?

We don't talk about NPs taking over urology (partially because it's a surgical specialty, I get that, but still). We don't talk about urology residencies popping up all over the place and saturating the market. I'm not sure what the underlying economics of it is, but I suspect there is a lot of demand for urologists, but urologists sit back and let the employers come begging. They are clearly in control of their own destiny.

Everyone and their mom wants to be an ED doc now. Every city/hospital needs more ED docs. Seems simple enough: satisfy the thirst and everyone benefits. But ultimately we are doing ourselves in.

I hate to paint a bleak picture, but this can't sustain itself forever and sooner or later the EM bubble will pop.

 

[TooMuchResearch]

Question. Would going to one of these HCA residencies hinder chances of finding a job? Why are people so against this company? For pure training purposes, are there any negatives to HCA? Or are ya'll just on the HCA bandwagon because they are evil etc etc

Remember that time HCA/Emcare got sued for firing a whistle blower? Remember why the whistle was blown? Admission percent quotas: unnecessary testing to fish for admissions, iatrogenic harm, fraud.

You trust them to provide an education?

 

[MSmentor018]

Remember that time HCA/Emcare got sued for firing a whistle blower? Remember why the whistle was blown? Admission percent quotas: unnecessary testing to fish for admissions, iatrogenic harm, fraud.

You trust them to provide an education?

Doctor says she was fired for reporting low staffing at Brandon Regional ER

 

[MSmentor018]

I guess my question is, why is EM following the same path as anesthesia? Why do certain specialties follow the same path of over saturation, while other specialties say... urology, stay relevant and withstand the test of time for decades?

We don't talk about NPs taking over urology (partially because it's a surgical specialty, I get that, but still). We don't talk about urology residencies popping up all over the place and saturating the market. I'm not sure what the underlying economics of it is, but I suspect there is a lot of demand for urologists, but urologists sit back and let the employers come begging. They are clearly in control of their own destiny.

Everyone and their mom wants to be an ED doc now. Every city/hospital needs more ED docs. Seems simple enough: satisfy the thirst and everyone benefits. But ultimately we are doing ourselves in.

I hate to paint a bleak picture, but this can't sustain itself forever and sooner or later the EM bubble will pop.

just wait urology friends.....you're going to come under encroachment just like us. These on line DNP program mills are cranking 'em out in any flavor you want. here's an example of the urology "doctor" I randomly found just by typing "DNP urology". and the usual we provide equal to/better care than physicians, blah, blah, blah....

http://www.renalandurologynews.com/...rees-deserve-the-title-doctor/article/214289/

 

[goodoldalky]

I guess my question is, why is EM following the same path as anesthesia? Why do certain specialties follow the same path of over saturation, while other specialties say... urology, stay relevant and withstand the test of time for decades?

We don't talk about NPs taking over urology (partially because it's a surgical specialty, I get that, but still). We don't talk about urology residencies popping up all over the place and saturating the market. I'm not sure what the underlying economics of it is, but I suspect there is a lot of demand for urologists, but urologists sit back and let the employers come begging. They are clearly in control of their own destiny.

Everyone and their mom wants to be an ED doc now. Every city/hospital needs more ED docs. Seems simple enough: satisfy the thirst and everyone benefits. But ultimately we are doing ourselves in.

I hate to paint a bleak picture, but this can't sustain itself forever and sooner or later the EM bubble will pop.

It’s pretty simple: many of the newer EM residency programs are brought online by contract management groups. Why? Because they have an interest in influencing the local job market, including driving supply up, in order to keep expenses/costs down and give an advantage to keeping good graduating residents within their system.

How many team health, EMcare, USACS affiliated programs are there now? A dozen? That’s 100+ residents a year probably...

 

[EctopicFetus]

Remember that time HCA/Emcare got sued for firing a whistle blower? Remember why the whistle was blown? Admission percent quotas: unnecessary testing to fish for admissions, iatrogenic harm, fraud.

You trust them to provide an education?

They will learn how to be sheep and get raped by the CMGs while taking marching orders from low level semi ******ed suits with MBAs from online crap schools. They will learn..

 

[mymembernames]

With so many new programs opening up, I am on the one hand happy for more spots in EM, but also worried how this will impact the future of EM? Will jobs or pay become a problem?

 

[sfwtboy]

Please read this thread that is currently on the front page.
Are we tying our nooses w/ residency expansion?

/End thread

 

[hundreddaysoff]

With so many new programs opening up, I am on the one hand happy for more spots in EM, but also worried how this will impact the future of EM? Will jobs or pay become a problem?

At the end of the day, lots of people have theories but no one knows. No one can predict the future. If I could predict the future, I wouldn't have gone to med school.

It's prudent to expect pay in EM to drop a bit over the next few years, for the reasons discussed above. We've had a pretty good run and usually things that are popular and lucrative tend to become less popular and less lucrative over time. And but that's what they predicted about anesthesiology and radiology 10 years ago and I haven't seen too many of those specialists starving in the streets.

Due to the way billing works, there's no reason to think we'll ever make less money than primary care. Conceivably it might be harder to get a job in the ER vs primary care in the future, but there's no evidence that is happening yet.

If you don't like EM, don't go into it. If you're like me and EM is the only specialty you really enjoy, then you should still go into it. If you're in between, then I guess it gets harder...

 

[Siggy]

It’s pretty simple: many of the newer EM residency programs are brought online by contract management groups. Why? Because they have an interest in influencing the local job market, including driving supply up, in order to keep expenses/costs down and give an advantage to keeping good graduating residents within their system.

On the IM side, the EMCare/Envision/HCA leadership managed to brains wash numerous residents that seeing 25-30 patients a day as a hospitalist is normal. It seriously makes me shake my head because and tempts me to buy shares of EVHC.

 

[EctopicFetus]

On the IM side, the EMCare/Envision/HCA leadership managed to brains wash numerous residents that seeing 25-30 patients a day as a hospitalist is normal. It seriously makes me shake my head because and tempts me to buy shares of EVHC.

See their stock performance the past 12 months. You may feel differently. When they get yanked off the sp500 their stock will plummet even more because every etf and mutual fund forced to buy them will sell and there won’t be anyone there to pick it up.

 

[The Knife & Gun Club]

See their stock performance the past 12 months. You may feel differently. When they get yanked off the sp500 their stock will plummet even more because every etf and mutual fund forced to buy them will sell and there won’t be anyone there to pick it up.

Why do you think they’re going to be pulled from the SP500?