CMG Programs

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VA Hopeful Dr said:
Is that actually true? I looked up what the official difference is (its quite large) but I could also see places that have everything in place and COULD be a level 1 but choose not to so they don't get stuck with all of the local trauma.
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Yep. That is to say, you can be everything a level 1 is without the accreditation and still be a level 2. Or, you can be a bare minimum level 2 and lack certain sub-specialty surgeons.
There are plenty of large cities that don't have level 1 trauma centers (Corpus Christi TX), and some small ones that do (Greenville NC, Spartanburg SC).
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TeamHealth runs USF in Florida.
But I agree, plenty of places have adequate residencies that are operated by CMGs.
 
Dr.McNinja said:
Yep. That is to say, you can be everything a level 1 is without the accreditation and still be a level 2. Or, you can be a bare minimum level 2 and lack certain sub-specialty surgeons.
There are plenty of large cities that don't have level 1 trauma centers (Corpus Christi TX), and some small ones that do (Greenville NC, Spartanburg SC).
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I live in Spartanburg at present. I brought this up because I did my residency in Anderson and knew what we had available trauma wise as a level 2 center while doing med school in Columbia (I clearly like SC) and I saw what was available there. Huge difference. That said, even at a level 2 one would hope that if there is an EM residency it would be a higher functioning level 2 than what my unopposed FM hospital had.
 
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Yeah, but you can also go see some level 1s out there that are from the 40s and look terrible, and some shiny new level 2s. It's really hospital dependent, just like stroke centers and chest pain centers of "excellence".
Or, you know, the ACGME.
 
Dr.McNinja said:
Not always.
There isn't much difference between level 1 and 2 honestly. There are a ton of Level 1s without EM residencies, and a ton of Level 2s with.
However, I want to remind everyone that you can comment on the situation (CMG residencies, poor training sites) without being slanderous.
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Slander is untrue. I made two comments that are true. I simply commented that this hospital is listed as the 8th highest overbilling hospital in the country (charges >11x costs) and then went down the rabbit trail of what the local press thinks of the hospital. Suffice it to say, it seems like the northeast Florida area is suspect of the hospital and there is an article from the local paper saying that this was a money grab. It also looks like they lost trauma accreditation or were on probation for several years.

That doesn’t sounds like a great place to train the future EM docs of this country.
 
TimesNewRoman said:
Slander is untrue. I made two comments that are true. I simply commented that this hospital is listed as the 8th highest overbilling hospital in the country (charges >11x costs) and then went down the rabbit trail of what the local press thinks of the hospital. Suffice it to say, it seems like the northeast Florida area is suspect of the hospital and there is an article from the local paper saying that this was a money grab. It also looks like they lost trauma accreditation or were on probation for several years.
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I wasn't naming anyone for having done it. I was warning people not to start doing it.
That doesn’t sounds like a great place to train the future EM docs of this country.
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I don't necessarily disagree, but I don't have any knowledge to the contrary. I do think that we need to pressure AAEM to maybe direct a little more light onto the ACGME process, as it seems like it has gotten much easier over the last decade to start up a residency.
 
Overall I agree the distinction between level 1 and 2 doesn’t matter as much as the volume and acuity of patients.

That being said future EM residents need to know the most HCA hospitals like Orange Park see very few severely injured trauma patients.
 
GeneralVeers said:
In fairness the USACS at UNLV has been there for 15 years, even back before it was EMP. It's the only Level I trauma center in the city with 20+ residencies, and sees over 100K patients/year with a dedicated peds area.

It's actually a proper academic residency, unlike the crappy one that United Hospital Services is forcing down our throats at a neighboring community hospital.
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Probably have to tell the residents to stop telling applicants that the schedule from that program ruined all their lives. Also trauma is in a separate building and it sounds like the EM role is incredibly insignificant.
 
alpinism said:
Overall I agree the distinction between level 1 and 2 doesn’t matter as much as the volume and acuity of patients.

That being said future EM residents need to know the most HCA hospitals like Orange Park see very few severely injured trauma patients.
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I'm not defending one program over another, but why does everyone think the core of emergency medicine is trauma? Working in a very busy trauma center, it's all bread and butter. Going through differentials on really sick medical patients is more challenging. Granted, it's not as sexy as trauma.
 
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southerndoc said:
I'm not defending one program over another, but why does everyone think the core of emergency medicine is trauma? Working in a very busy trauma center, it's all bread and butter. Going through differentials on really sick medical patients is more challenging. Granted, it's not as sexy as trauma.
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For whatever reason people still measure the worth of a program via procedural experience alone, except that's the easiest part of EM.
 
I can teach myself new medical skills. I can also teach myself new procedural skills. I'm not sure how well learning new procedural skills would go without a very solid base upon which to build. Hopefully every program provides good medical training, so I think the procedural training is very important. I do so many fewer procedures out in the community than in residency. In residency, there was a risk of running out of laryngoscope blades because we had to use them all. In the community, there is a risk of running out of laryngoscope blades because someone forgot to stock them and doesn't remember where they are stored.
Rekt said:
For whatever reason people still measure the worth of a program via procedural experience alone, except that's the easiest part of EM.
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Here's the problem I see with dumping a residency program on a community hospital:
Sending the residents out for rotation such as trauma, SICU, and pediatrics.
No one is fellowship trained - just who is supposed to teach ultrasound and toxicology?
The pediatric emergency department is staffed by pediatricians - which will be a real problem for accreditation.
Most of the attendings are not published, not interested in research, and not even all that interested in teaching.
I'm not sure independent contractors for a CMG can be forced to take on additional responsibilities of teaching anyway.
 
deuist said:
Here's the problem I see with dumping a residency program on a community hospital:
1. Sending the residents out for rotation such as trauma, SICU, and pediatrics.
2. No one is fellowship trained - just who is supposed to teach ultrasound and toxicology?
3. The pediatric emergency department is staffed by pediatricians - which will be a real problem for accreditation.
4. Most of the attendings are not published, not interested in research, and not even all that interested in teaching.
I5. 'm not sure independent contractors for a CMG can be forced to take on additional responsibilities of teaching anyway.
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To whit.
1. Not really an issue. If you could go to Parkland, say, and get your 10 deliveries in a weekend instead of month, would you?
2. I thought everyone had an honorary US fellowship at this point. Tox, OTOH, I would bet 1/2 the residencies have less than 1 faculty member
3. Community shops don't have peds EDs in general. And if staffed by peds, they can't supervise the residents.
4. Most of my published attendings were the worst at clinical medicine. There's a happy medium, for sure. But I bet working for Ian Stiehl is annoying.
5. You're not wrong. They're moving the meat. However, you need some faculty to push this perspective, because that's what 95%+ of the grads will do when they leave. Move the meat.
 
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Rekt said:
What's your response to the ridiculous amount of residencies opening? What is your actual reasoning behind opening one? Why do you think we need another emergency medicine residency? Where do you expect your graduates will go if PHX already saturated from Copa and UA? What's your thoughts on misleading students selling the program under the guise of a "big bad trauma center" when PHX has a very abnormally high trauma center to population ratio?
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Image result for you're talking to my guy all wrong gif307 × 200
 
This is getting more and more ridiculous all the time. Within 10 years we're going to be making FM pay.
 
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Rekt said:
What's your response to the ridiculous amount of residencies opening? What is your actual reasoning behind opening one? Why do you think we need another emergency medicine residency? Where do you expect your graduates will go if PHX is already saturated from Copa and UA? What's your thoughts on misleading students selling the program under the guise of a "big bad trauma center" when PHX has a very abnormally high trauma center to population ratio?
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Watch out. Some non EM mod will come in here and put you on probation.
 
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How are you guys sending your sloes? are you asking your aways to send your sloe directly to the program? awkward.... major deterrent to me applying
 
cyanide12345678 said:
Roughly 200-220/hour from what I've seen and heard.
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*Under the CMG banner as well.

If I remember right, there might be one SDG left, but I wouldn't be surprised if that got taken over too.
 
I worked in Phoenix for 6 years. Market is dead there. I moved
 
NYEMMED said:
I would not call that really low, many markets are now 140-150/ hour. That is low.
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Those wages are horrible ! With the new residency opening up it will drive the salaries that low as well.

Can’t blame new grads since old EM attendings flock to programs like this.
 
Dr.McNinja said:
Vituity is trying really, really hard here.

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Physician group practice models shape the work lives of providers. Unfortunately, some groups try to look like partnerships without offering the benefits.
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I think this is a big giant jab at USACS. Which I'm happy with, all day.

There ARE a lot of squirrely arrangements out there. SDGs that bring on new docs as W2 employees - MAYBE you'll make partner, maybe not. Different "tiers" of partnership that are nebulous, without guaranteed promotion. Crap like that.
 
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You guys think Arizona is bad?

Texas will be starting 4 new programs in the next 2 years.
 
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Well, here goes my dream of going EM, pay my loans in 5 years, enjoy a nice schedule, have time for my family, and make a decent living.
 
Dr.McNinja said:
4?
TTU-Lubbock is the only one I'm aware of. What else?
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alpinism said:
You guys think Arizona is bad?

Texas will be starting 4 new programs in the next 2 years.
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FML.

I wanted to move to Texas in two years.

How do we get doctors to join together and stop taking these positions to stop proliferation??????
 
cyanide12345678 said:
FML.

I wanted to move to Texas in two years.

How do we get doctors to join together and stop taking these positions to stop proliferation??????
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Beats me. El Paso is desperate for docs. Can't necessarily fault them.


I'm more annoyed by South Texas and the rest of the panhandle honestly.
 
Dr.McNinja said:
Beats me. El Paso is desperate for docs. Can't necessarily fault them.


I'm more annoyed by South Texas and the rest of the panhandle honestly.
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El paso already has a decent sized residency program as well.

Literally El paso is one of the few big cities left in Texas offering $300/hour.

Guess that will change very soon then.
 
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Brigade4Radiant said:
Those wages are horrible ! With the new residency opening up it will drive the salaries that low as well.

Can’t blame new grads since old EM attendings flock to programs like this.
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I would not call 150/hr horrible... If IM/FM got that, it's literally 300k/yr
 
Fox800 said:
It's literally the bottom of the bottom for EM. So yes, compared to most of the US, it is horrible.
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I know... I am an IM resident, I think EM is the best specialty in medicine after talking to 2 EM attending during my ED rotation. These 2 attendings work 8 nights/month ( basically 2 days/wk) and they told me that they make 200k+/yr and it's full time (aka they have all the benefits).
 
Splenda88 said:
I know... I am an IM resident, I think EM is the best specialty in medicine after talking to 2 EM attending during my ED rotation. These 2 attendings work 8 nights/month ( basically 2 days/wk) and they told me that they make 200k+/yr and it's full time (aka they have all the benefits).
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EM work is vastly different than IM hence all the burnout.
 
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Splenda88 said:
According the Medscape, IM/EM burnout rate is virtually identical

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Ah yes, Medscape. The mecca of factual and statistically significant information.

You can probably contact some of these garbage tier EM programs opening and transfer since you're so infatuated with EM. Although, you'll probably be in a world of hurt after they work you like a slave. I'm guessing your EM attendings put you on the back burner as an off service resident so you don't really have an idea of how much different it is to work EM vs a floor.
 
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Rekt said:
Ah yes, Medscape. The mecca of factual and statistically significant information.

You can probably contact some of these garbage tier EM programs opening and transfer since you're so infatuated with EM. Although, you'll probably be in a world of hurt after they work you like a slave. I'm guessing your EM attendings put you on the back burner as an off service resident so you don't really have an idea of how much different it is to work EM vs a floor.
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I am not sure why you think I am infatuated with EM. I am perfectly content being an IM doc.
 
Splenda88 said:
I would not call 150/hr horrible... If IM/FM got that, it's literally 300k/yr
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It’s horrible for EM.

EM has a faster pace. It is more time critical. It has much higher stress and liability. Accordingly EM pay would need to be higher than FM or IM
 
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