Current Future of Emergency Medicine

[Tenk]

Is bleak:



ACEP hosted a webinar yesterday and just around the time some of you future little EM Docs graduate from residency, there may not be jobs.

There is a large bloat of terrible EM programs hosted by CMGs (groups that buy contracts in EDs and staff them (ie TeamHealth)) and they are flooding our market with a surplus of grads. Covid has played a large part in this as well. This has been a rapid progression though. Just a few years ago my phone was blowing up with locums offers every day. Now, nothing.

The reason I post this is because people who are graduating now are already having trouble finding jobs so who the hell knows. Academic programs are usually sheltered from reality though so nobody else may tell you this. 5 years ago I told everyone they should go into EM. Today I would say find anything else. Things may change but I would monitor this situation carefully before you sign your future away and wind up 3-7 years later unemployed.

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[Matthew9Thirtyfive]

Most people probably won’t listen. The overestimation of the odds of being the one person who will be fine is strong.

 

[Lawpy]

Is EM the new radonc in job market saturation and field collapse?

 

[Rekt]

Is EM the new radonc in job market saturation and field collapse?

Worse.

Here's the relevant pictures everyone needs to see;

They need to cut spots by 1120 a year to reach a slim equilibrium, which is extremely unlikely to even come close to happening.

The main solution proposed by ACEP President-Elect is to make every program 4 years.

Also @RustedFox eloquently summarized the rest of their "solutions" from the presentation.

"I'm not sure if it was in this thread that you summarized the ACEP clown's suggestions for the future workforce; but it was :

1.) Rural spots (okay, PLPs are doing this, and ACEP itself says that PLP/FP/IM can do it for cheaper.)

2.) Telehealth (this is the antithesis of what we're trained to do.)

3.) Correctional medicine (so, go work for a jail... Okay, those ads all list "IM preferred" right in the requirements section of the description.)

4.) "Proceduralist" (Lol. This doesn't exist.)

So, thanks for nothing there, ACEP"


Also, to show you further the state of EM. Here's this piece of human garbage that was the previous president of ACEP

 

[deleted1064759]

Pathology/RadOnc/Gas residents:

 

[Lawpy]

Worse.

Here's the relevant pictures everyone needs to see;

View attachment 334531
View attachment 334532

They need to cut spots by 1120 a year to reach a slim equilibrium, which is extremely unlikely to even come close to happening.

The main solution proposed by ACEP President-Elect is to make every program 4 years.

Also @RustedFox eloquently summarized the rest of their "solutions" from the presentation.

"I'm not sure if it was in this thread that you summarized the ACEP clown's suggestions for the future workforce; but it was :

1.) Rural spots (okay, PLPs are doing this, and ACEP itself says that PLP/FP/IM can do it for cheaper.)

2.) Telehealth (this is the antithesis of what we're trained to do.)

3.) Correctional medicine (so, go work for a jail... Okay, those ads all list "IM preferred" right in the requirements section of the description.)

4.) "Proceduralist" (Lol. This doesn't exist.)

So, thanks for nothing there, ACEP"


Also, to show you further the state of EM. Here's this piece of human garbage that was the previous president of ACEP who won speaker of the year.
View attachment 334535



View attachment 334536

Is EM the only specialty that requires SLOEs? Because i don't know why anyone will waste time with aways and gamble on good SLOEs on a rapidly saturating and declining field

 

[Lawpy]

I think this news killed whatever remaining interest i had in EM. I already had a lot of problems with the SLOE system/aways but this news really put a nail on that coffin

 

[Rekt]

Is EM the only specialty that requires SLOEs? Because i don't know why anyone will waste time with aways and gamble on good SLOEs on a rapidly saturating and declining field

I remember Orthopedics dabbling in something similar when I was applying and maybe one other surgical specialty, but no specialty is close to EMs SLOE requirement. You essentially cannot apply to any program without at least one.

I think this news killed whatever remaining interest i had in EM. I already had a lot of problems with the SLOE system/aways but this news really put a nail on that coffin

There will be some anti-doomer boomers that tell you you'll have plenty of prospects, but I think that's a very smart decision. Remember that current EM residents (me) and attendings like Tenk and others in the EM forum don't have anything to gain by warning people not to go into EM. It's not going to help us any. I think taking a deep look at where EM is going is important before deciding to do it. If I could save one person from being in my position and a lot of my fellow colleague residents now looking at the market with extreme anxiety and depression then it's worth it.

 

[Tenk]

I think this news killed whatever remaining interest i had in EM. I already had a lot of problems with the SLOE system/aways but this news really put a nail on that coffin

All my attending friends are saying the same thing atm: iron death grip on their current job. Which means no matter how crappy it gets we’re just going to hold onto what we got. Before you had more power because you could just leave and work elsewhere.

One of my good friends is going to be applying to med school this year and I’m telling him to do something else even though he really enjoys EM.

 

[Lawpy]

All my attending friends are saying the same thing atm: iron death grip on their current job. Which means no matter how crappy it gets we’re just going to hold onto what we got. Before you had more power because you could just leave and work elsewhere.

One of my good friends is going to be applying to med school this year and I’m telling him to do something else even though he really enjoys EM.

Can EM PDs at least stop requiring SLOEs permanently? Because it makes no sense to stress out on aways and SLOEs in a field that's going to crash

 

[FrkyBgStok]

Most people probably won’t listen. The overestimation of the odds of being the one person who will be fine is strong.

I am only quoting this because it is going to be one of the most important comments on the thread and I want med students to read it again.

 

[DO2015CA]

It’s crazy how times change. When I was a med student this was the hot commodity. Everyone was wanting EM. Honestly glad I hated my EM core. Sorry guys. Hopefully it will even out. Or better, there will be enough EM in the ER that others get pushed out leading to better care in even the smaller ERs

 

[Lawpy]

It’s crazy how times change. When I was a med student this was the hot commodity. Everyone was wanting EM. Honestly glad I hated my EM core. Sorry guys. Hopefully it will even out. Or better, there will be enough EM in the ER that others get pushed out leading to better care in even the smaller ERs

It went the way of radonc. Everyone with 270+/straight honors/AOA/nature pubs were fighting tooth and nail for a radonc spot several years ago and now the field has crashed

 

[RespectTheChemistry]

So sad. I am so sorry this is happening to current and especially graduating residents.

 

[BrainScanner76]

I'm an M3 going back and fourth between EM and FM., maybe doing a combined EM/FM or EM/IM. I thought I made up my mind to just do straight EM, but now I have no idea what I should do.

 

[Gilakend]

Pathology/RadOnc/Gas residents:

Is Gas that bad? I obviously knew about midlevel encroachment but didn't know it was to the level of Path/Rad Onc.

This is all pretty bad news for someone who is mainly interested in a competitive specialty but was thinking EM or Gas as a secondary 💀

 

[jambro]

Is Gas that bad? I obviously knew about midlevel encroachment but didn't know it was to the level of Path/Rad Onc.

This is all pretty bad news for someone who is mainly interested in a competitive specialty but was thinking EM or Gas as a secondary 💀

I think there's warning signs for anesthesia but i don't think it's accurate to put it with path and rad onc at all

 

[Tenk]

Can EM PDs at least stop requiring SLOEs permanently? Because it makes no sense to stress out on aways and SLOEs in a field that's going to crash

Unlikely.

 

[Lem0nz]

GAS is probably fine. People are taking the one off anecdotes of physicians being replaced at xxxx facility and blowing them to sky high proportions. Someone linked me another article about a bunch of IM docs being fired and replaced with midlevels, and then another article with a bunch of FM docs being fired from a chain of urgent cares and being replaced with midlevels being managed under EM physicians at the main ERs they're all linked to.

What those one offs fail to address is that normal market forces and contract negotiations happen all the time. My residency replaced half its general surgery department with employed physicians instead of the previously contracted private group who had a monopoly on the contract before them. They hired additional surgeons to fill the gaps after with a goal of eventually replacing all the private guys and moving to hospital controlled/employed model so they can shuttle the big cases to the center for better outcomes and move to a wheel and spoke model. My point being - these are normal market forces.

There WILL absolutely be doctors replaced by midlevels like that CRNA article in places across the country. Its very unlikely to happen with more than a couple percent of the physician workforce because of complexity, quality, and liability issues. Independent practice of a midlevel comes in two flavors - outpatient and they're doing their own billing which is its own separate beast, and hospital employed. Hospitals are not stupid. They will seek to find a steady state of best profits with least risk. That is very unlikely to be completely midlevel/CRNA replaced. Its very likely to be midlevels overseen by MDs. And there are still plenty of jobs for that and probably will be for a couple decades at least. There would have been in EM for certain except HCA done gone and messed it up. That has made it very real that midlevels are competing for physician jobs because there was also a physician oversupply. The physician oversupply was the primary driver though and the bigger issue. If you look at rad/onc and path - that was not a midlevel issue at all. Physicians screwed physicians.

TLDR~ GAS should be fine. But if you go into GAS recognize the future likely involves you overseeing CRNAs/AAs in some capacity, but you will also still do your own cases too. EM is well and truly ****ed. The top/academic and high powered community programs will find jobs but the paychecks will be worse. Who can say how worse, but best guess is you're looking at getting depressed to the 200-300k land. The other spots will be the new SOAP fills and those people will probably not find jobs.

 

[7331poas]

Dont touch anything that midlevels can encroach. I am just hoping rads stays good due to increased volume and AI still on the relatively distant horizon.

 

[Matthew9Thirtyfive]

They will seek to find a steady state of best profits with least risk.

In general I agree, but for many of these places they have thus far determined that eating the malpractice for midlevels is cheaper and therefore better. There’s a reason why midlevels are more likely to be absorbed by the hospital with physicians left on their own.

 

[mrbreakfast]

I think if you really like EM, particularly stabilizing unstable patients, it's still worth looking into. It might not be as lucrative, but working up the undifferentiated patient is interesting and I personally enjoy hanging out in the ED seeing consults, so I see the appeal.

The problem is, if your workup for every patient consists of ordering a CBC/BMP, a CT of some kind, consulting someone and asking them to take a history for you, and washing your hands of the patient, then a midlevel can do that. Obviously not every ED doc practices like that, but it certainly feels like a few do.

 

[Matthew9Thirtyfive]

I think if you really like EM, particularly stabilizing unstable patients, it's still worth looking into. It might not be as lucrative, but working up the undifferentiated patient is interesting and I personally enjoy hanging out in the ED seeing consults, so I see the appeal.

The problem is, if your workup for every patient consists of ordering a CBC/BMP, a CT of some kind, consulting someone and asking them to take a history for you, and washing your hands of the patient, then a midlevel can do that. Obviously not every ED doc practices like that, but it certainly feels like a few do.

It’s hard to enjoy your job if you don’t have a job.

 

[Lawpy]

Just got confirmed in EM forums and even this thread that SLOEs are here to stay

Nope nope nope. EM is hands down far worse than radonc for me at this point. Not touching this specialty at all.

 

[Skullcutter69]

GAS is probably fine. People are taking the one off anecdotes of physicians being replaced at xxxx facility and blowing them to sky high proportions. Someone linked me another article about a bunch of IM docs being fired and replaced with midlevels, and then another article with a bunch of FM docs being fired from a chain of urgent cares and being replaced with midlevels being managed under EM physicians at the main ERs they're all linked to.

What those one offs fail to address is that normal market forces and contract negotiations happen all the time. My residency replaced half its general surgery department with employed physicians instead of the previously contracted private group who had a monopoly on the contract before them. They hired additional surgeons to fill the gaps after with a goal of eventually replacing all the private guys and moving to hospital controlled/employed model so they can shuttle the big cases to the center for better outcomes and move to a wheel and spoke model. My point being - these are normal market forces.

There WILL absolutely be doctors replaced by midlevels like that CRNA article in places across the country. Its very unlikely to happen with more than a couple percent of the physician workforce because of complexity, quality, and liability issues. Independent practice of a midlevel comes in two flavors - outpatient and they're doing their own billing which is its own separate beast, and hospital employed. Hospitals are not stupid. They will seek to find a steady state of best profits with least risk. That is very unlikely to be completely midlevel/CRNA replaced. Its very likely to be midlevels overseen by MDs. And there are still plenty of jobs for that and probably will be for a couple decades at least. There would have been in EM for certain except HCA done gone and messed it up. That has made it very real that midlevels are competing for physician jobs because there was also a physician oversupply. The physician oversupply was the primary driver though and the bigger issue. If you look at rad/onc and path - that was not a midlevel issue at all. Physicians screwed physicians.

TLDR~ GAS should be fine. But if you go into GAS recognize the future likely involves you overseeing CRNAs/AAs in some capacity, but you will also still do your own cases too. EM is well and truly ****ed. The top/academic and high powered community programs will find jobs but the paychecks will be worse. Who can say how worse, but best guess is you're looking at getting depressed to the 200-300k land. The other spots will be the new SOAP fills and those people will probably not find jobs.

A lot of great discussion going on here. It is true that a lot of hospital networks are doing their best to snap up surgical/medical practices in order to maintain a longitudinal network of referrals -> in house surgeons with facility fees. However, this isn’t at all comparable to what’s going on in anesthesia, radiology, or EM.

A couple of great recent examples in the field I know most about (neurosurgery). The University of Cincinnati issued an ultimatum to a top tier private practice group (the Mayfield Clinic) to come under their wing, ultimately resulting in a divorce and initial collapse of the residency program. Indiana University had a similar dispute and split with Goodman Campbell, and ended up hiring in house surgeons. If you look at the outcome of these disputes, however, the private groups ended up barely scathed and still maintain dominant positions in their market with huge revenues. There are a lot of reasons for this but essentially, a) as a subspecialty surgeon, you develop a niche and reputation that allows you to attract patients and maintain a referral network from local physicians (neurologists, FM, etc.) [aka you can always leave and take your patients with you], b) your services are required to maintain level I/II trauma certifications of other covering hospitals, and c) Medicare has removed many surgeries from the inpatient only list, allowing you to just take your cases and leave to an ASC if your demands aren't met. This, combined with the fact that it takes many years to train a board certified surgical subspecialist, with no easy replacement, offers substantial security.

By contrast, in fields like anesthesia or EM, you a) do not own any patients. Patients are essentially assigned to you and in all honesty could not care less who it is that they get, b) are completely dependent on demand that is generated by others (either surgical cases or ED shifts), c) vulnerable to corporate takeover in a way that surgical/procedural specialties rarely are (this is a key point, since the cost savings are predominantly driven by greedy PE/VC bought groups, and d) there is a clear “alternative” competitor workforce that is continuously proliferating, with no end in sight to the opening of new schools (CRNA/NP). As painful as it is to admit (and I myself would want an MD anesthesiologist for myself, my family, and my patients), in 99% of cases (even in neurosurgery) nothing bad happens if the case is run by a CRNA with the MD only present at extubation (ie most of the cases that I had in residency). That’s why this stuff is allowed to happen and will unfortunately continue to do so.

 

[Lem0nz]

In general I agree, but for many of these places they have thus far determined that eating the malpractice for midlevels is cheaper and therefore better. There’s a reason why midlevels are more likely to be absorbed by the hospital with physicians left on their own.

You are right, but I think this is because we're still in the immediate gratification stage of "omg midlevels are cheaper!". I suspect this will last for another five to ten years. We'll see the pendulum swing the other direction then, probably over correcting, then we'll hit steady state. The whole process is going to take a decade or two to play out.

There are definitely some very forward looking organizations out there that are both profitable and thinking about this sort of stuff now rather than a couple decades from now and who are employing tons of midlevels, but aren't replacing their physicians and instead are being very diligent about making sure their midlevels and physicians are making robust teams with good oversight, and that the midlevels are being used to keep physicians constantly either doing procedures or doing decision making and then using midlevels to execute the plans around that. I'm really fortunate to be in one of those places now for fellowship and am going to work with one in the fall as an attending. I rightly don't know if they are the majority or the minority, but they're fantastic places to work.

 

[Matthew9Thirtyfive]

You are right, but I think this is because we're still in the immediate gratification stage of "omg midlevels are cheaper!". I suspect this will last for another five to ten years. We'll see the pendulum swing the other direction then, probably over correcting, then we'll hit steady state. The whole process is going to take a decade or two to play out.

There are definitely some very forward looking organizations out there that are both profitable and thinking about this sort of stuff now rather than a couple decades from now and who are employing tons of midlevels, but aren't replacing their physicians and instead are being very diligent about making sure their midlevels and physicians are making robust teams with good oversight, and that the midlevels are being used to keep physicians constantly either doing procedures or doing decision making and then using midlevels to execute the plans around that. I'm really fortunate to be in one of those places now for fellowship and am going to work with one in the fall as an attending. I rightly don't know if they are the majority or the minority, but they're fantastic places to work.

Yeah I think you’re right. I’m generally in favor of market forces. If someone else can do the same job and do it cheaper, then so be it. The problem is midlevels can’t do the same job. So when these docs get replaced by midlevels, it isn’t just the docs being hurt. It’s the patients too.

 

[sloop]

This is sad but I also can’t say I’m too surprised. EM salaries have been in some sense “too good” for a field with a 3 year residency and for which the main practical/infrastructural barrier to creating a residency is “have an emergency department.”

 

[deleted966164]

Well... now that there is still plenty time to switch fields... I went to medical school with a strong intent to do EM. I like trauma. I like critical stuff. What other specialty would fit? I know this somehow sounds like a stupid question - I'm just getting very depressed...

 

[Lem0nz]

Yeah I think you’re right. I’m generally in favor of market forces. If someone else can do the same job and do it cheaper, then so be it. The problem is midlevels can’t do the same job. So when these docs get replaced by midlevels, it isn’t just the docs being hurt. It’s the patients too.

That statement right there strikes at the heart of it. Whether you're pro or anti mid level, this is America and we're a capitalist society and medicine IS a business here. We can legislate that away and make it a right and do universal healthcare, but we haven't and most don't currently want that.

We have yet to define what needs a doctor and what doesn't. We have only recently (last decade or so) come up with very well defined evidence based algorithms that are quite thorough for most diseases and cover 1st through 5th line treatments. Does it need a doctor to implement those algorithms? When does it? When does it not?

We don't know. The midlevel experiment is going to give us our first lowest level of evidence which is anecdotal. It will be followed with cost and harm analysis and outcomes data because all of that data collection already exists, but we need more time and more evolution of the process to extract it. That's what's going to take twenty years. Then we'll know. Maybe you can replace primary care for half of America with a midlevel and the risk of harm is minimal. Maybe you can use CRNAs for ASA 1-3. If its safe enough and reduces costs, it is what we should be doing. We have to define safe enough. The definition shouldn't vary from MD or midlevels, it should be constant. We're also just now doing that for MDs. To err is human from IOM is only 20 years old and we've done very little to make meaningful impact on reducing harm at all levels, but we're starting to move the needle. We also need to compare MD alone to MD supervised to independent midlevel and really define those things, and have enough in each sample group to make meaningful inferences. We haven't and we don't, yet. We will.

It's going to take a long, long time to figure all that out.

 

[Lem0nz]

Well... now that there is still plenty time to switch fields... I went to medical school with a strong intent to do EM. I like trauma. I like critical stuff. What other specialty would fit? I know this somehow sounds like a stupid question - I'm just getting very depressed...

Trauma surgery.

 

[Matthew9Thirtyfive]

That statement right there strikes at the heart of it. Whether you're pro or anti mid level, this is America and we're a capitalist society and medicine IS a business here. We can legislate that away and make it a right and do universal healthcare, but we haven't and most don't currently want that.

We have yet to define what needs a doctor and what doesn't. We have only recently (last decade or so) come up with very well defined evidence based algorithms that are quite thorough for most diseases and cover 1st through 5th line treatments. Does it need a doctor to implement those algorithms? When does it? When does it not?

We don't know. The midlevel experiment is going to give us our first lowest level of evidence which is anecdotal. It will be followed with cost and harm analysis and outcomes data because all of that data collection already exists, but we need more time and more evolution of the process to extract it. That's what's going to take twenty years. Then we'll know. Maybe you can replace primary care for half of America with a midlevel and the risk of harm is minimal. Maybe you can use CRNAs for ASA 1-3. If its safe enough and reduces costs, it is what we should be doing. We have to define safe enough. The definition shouldn't vary from MD or midlevels, it should be constant. We're also just now doing that for MDs. To err is human from IOM is only 20 years old and we've done very little to make meaningful impact on reducing harm at all levels, but we're starting to move the needle. We also need to compare MD alone to MD supervised to independent midlevel and really define those things, and have enough in each sample group to make meaningful inferences. We haven't and we don't, yet. We will.

It's going to take a long, long time to figure all that out.

I mean it will take a while to do it for all fields. But there are a fair number of studies showing that even supervised (since there actually aren’t any studies looking at independent practice), they provide inferior care in outpatient and inpatient settings. The key part of these studies is that they tend to cost the patient either the same or more and drive money to the hospital. They are a cash cow that is making their employers more money, and as long as the cost of covering their mistakes is lower than the money they drive to the c suite, they will continue to be hired and promoted.

 

[MedScat]

Trauma surgery.

Trauma is so different than EM I don't understand why people act like they are the same. Do a trauma rotation then do an EM rotation and see which one is nicer for lifestyle (amongst other things). Trauma is very much SURGERY, EM is not.

disclaimer: yea yea i understand if you don't have a job your lifestyle will suck regardless, saving you the comment later.

 

[Lem0nz]

Trauma is so different than EM I don't understand why people act like they are the same. Do a trauma rotation then do an EM rotation and see which one is nicer for lifestyle (amongst other things). Trauma is very much SURGERY, EM is not.

disclaimer: yea yea i understand if you don't have a job your lifestyle will suck regardless, saving you the comment later.

Most of trauma has moved to non-operative management, most of trauma is shift work, and the operative volume (particularly if you don't do acute care which is possible or can be minimized if you do ICU) is low. I have done an EM rotation and trauma... thanks. :\

Edit: The guy specifically also said, "I like trauma. I like critical stuff."

 

[MedScat]

Most of trauma has moved to non-operative management, most of trauma is shift work, and the operative volume (particularly if you don't do acute care which is possible or can be minimized if you do ICU) is low. I have done an EM rotation and trauma... thanks. :\

Edit: The guy specifically also said, "I like trauma. I like critical stuff."

As a measly MS3 idk, i guess my experience was different. At my institution (level 1 trauma center) trauma does Q3 24 hour call which is VERY different to EM....and they spend a lot a lot of time in the OR

As someone who liked EM i thought i would enjoy my trauma rotation and i most certainly did not because I was too exhausted to enjoy it. Was not trying to be rude my friend, i guess experiences vary

 

[Matthew9Thirtyfive]

Most of trauma has moved to non-operative management, most of trauma is shift work, and the operative volume (particularly if you don't do acute care which is possible or can be minimized if you do ICU) is low. I have done an EM rotation and trauma... thanks. :\

Edit: The guy specifically also said, "I like trauma. I like critical stuff."

Yeah we do trauma as part of our surgery rotation. At least 90% of it was non-operative, and the attendings were doing shift work. Basically hospitalist schedule with a less predictable day at work and the potential to operate. They did elective stuff when they weren’t on their week of trauma.

 

[Matthew9Thirtyfive]

As a measly MS3 idk, i guess my experience was different. At my institution trauma does Q3 24 hour call which is VERY different to EM....and they spend a lot a lot of time in the OR

As someone who liked EM i thought i would enjoy my trauma rotation and i most certainly did not because I was too exhausted to enjoy it. Was not trying to be rude my friend, i guess experiences vary

Definitely not like that at the level 1 center here. Shift work, the vast majority of patients did not go to the OR.

 

[MedScat]

Definitely not like that at the level 1 center here. Shift work, the vast majority of patients did not go to the OR.

We have a fair number of GSWs and blunt traumas daily that pretty much all end up going to the OR...if they make it. I thought this was all of trauma everywhere. Good to know its not, and for others to know its not as well.

 

[Lem0nz]

As a measly MS3 idk, i guess my experience was different. At my institution (level 1 trauma center) trauma does Q3 24 hour call which is VERY different to EM....and they spend a lot a lot of time in the OR

As someone who liked EM i thought i would enjoy my trauma rotation and i most certainly did not because I was too exhausted to enjoy it. Was not trying to be rude my friend, i guess experiences vary

There's only a handful of trauma centers left like what you're describing. Temple, Ryder. Probably LA. Most are not that. And once you step outside a city into the suburbs with level two trauma to acuity dramatically drops.

You just have to get through the surgical residency. Shrug. Surgical residency sounds better than unemployment. Marginally.

 

[MedScat]

There's only a handful of trauma centers left like what you're describing. Temple, Ryder. Probably LA. Most are not that. And once you step outside a city into the suburbs with level two trauma to acuity dramatically drops.

You just have to get through the surgical residency. Shrug. Surgical residency sounds better than unemployment. Marginally.

Yessir/maam, ding ding ding, I'm at Temple. And yes, I'm not sure one would pay me enough for surgical residency

 

[Matthew9Thirtyfive]

We have a fair number of GSWs and blunt traumas daily that pretty much all end up going to the OR...if they make it. I thought this was all of trauma everywhere. Good to know its not, and for others to know its not as well.

For example, out of 10 traumas in a 12 hour shift, 2 were GSWs and the rest were blunt trauma. MVCs, horse accidents, etc. It varies depending on where you go. Here we get a lot of border wall jumpers who get ****ed up on the way down or while running from BPD.

 

[Lem0nz]

Yea. Temple's thug AF. That was a hard two months for me and I did not enjoy it. No where else in Philly is like that.

 

[mrbreakfast]

Well... now that there is still plenty time to switch fields... I went to medical school with a strong intent to do EM. I like trauma. I like critical stuff. What other specialty would fit? I know this somehow sounds like a stupid question - I'm just getting very depressed...

EM or IM -> critical care fellowship, maybe. Someone who knows more about those pathways can comment more, but if you like critically ill, unstable, often undifferentiated patients, it seems at most hospitals those types gravitate to the MICU. The downside if you probably wouldn't enjoy the three years of IM required to get you there, and I'm not certain how common EM-trained MICU attendings are.

 

[la flame]

EM docs at my hospital work the night shifts in the ICU since their is no intensivist at night besides an NP. Is this common in the US? I’ve asked and none have any type of critical care fellowship or training.

 

[sloop]

The other thing I will say is that, if one has an interest in mental health, you can easily be a psychiatrist who spends nearly all of their time in the ED and make good money.

I also know that’s a big caveat because my experience is that many people who wind up in EM actually really dislike psych patients. But if you do enjoy them, working in a PES can be a good fit. You get to work closely with the EM team, manage your own workflow based on acuity and department needs, and provide a service that the EM team really needs. You get to work with undifferentiated patients. Many times I wind up seeing people before the EM provider has even examined them. It’s also shift work and when you’re done you get to pass everything off to the next provider and you don’t have to worry about it anymore until your next shift.

 

[DO2015CA]

EM docs at my hospital work the night shifts in the ICU since their is no intensivist at night besides an NP. Is this common in the US? I’ve asked and none have any type of critical care fellowship or training.

Have never seen it

 

[Redpancreas]

Is bleak:



ACEP hosted a webinar yesterday and just around the time some of you future little EM Docs graduate from residency, there may not be jobs.

There is a large bloat of terrible EM programs hosted by CMGs (groups that buy contracts in EDs and staff them (ie TeamHealth)) and they are flooding our market with a surplus of grads. Covid has played a large part in this as well. This has been a rapid progression though. Just a few years ago my phone was blowing up with locums offers every day. Now, nothing.

The reason I post this is because people who are graduating now are already having trouble finding jobs so who the hell knows. Academic programs are usually sheltered from reality though so nobody else may tell you this. 5 years ago I told everyone they should go into EM. Today I would say find anything else. Things may change but I would monitor this situation carefully before you sign your future away and wind up 3-7 years later unemployed.

Aren't ya EM?

 

[efle]

I'm glad SDN exists so people can see discussions about job markets and learn what happened to RadOnc / what is currently happening to EM.

I have never once during medical school heard anyone discuss this as part of their specialty choice. Don't know if people just don't want to come off poorly for choosing around that...or if most med students don't have any clue its happening.

 

[deleted966164]

I'm glad SDN exists so people can see discussions about job markets and learn what happened to RadOnc / what is currently happening to EM.

I have never once during medical school heard anyone discuss this as part of their specialty choice. Don't know if people just don't want to come off poorly for choosing around that...or if most med students don't have any clue its happening.

Most of us have no idea this is happening. A lot of us are focused on showing each other cat/dog photos...

 

[DO2015CA]

I think we should be emphasizing both job market and life style more during medical school. What’s important to you during med school often time changes as you get older