Current Future of Emergency Medicine

[Banco]

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.

Agreed, but SDN is a very small sample size. These things are hardly every discussed and students more often than not don't really talk about such things with mentors or attendings.

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[Tenk]

Aren't ya EM?

Born and raised.

 

[jambro]

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

Honestly at some level I'm glad people don't because if everyone thought like me I'd be absolutely screwed. I thank god for all the primary care, peds, and surgery hopefuls

 

[ACSurgeon]

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...

Only if there was a field that combined Trauma and Critical Care...

 

[ACSurgeon]

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.

I did surgery/critical care and I am constantly amazed at how smart my medicine/cc partners are. Is is all from the fellowship? I bet some of it came from the IM portion. So, for anyone wants to do CC, IM training will likely serve them well

 

[ACSurgeon]

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

Not all surgical residencies are as miserable as temple. I interviewed there 10 years ago and they seemed run down with little support for the residents...

 

[ACSurgeon]

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.

part of the problem is a lot of docs have become focused on quantity over quality to the point where many IM/EM docs do a worse job than a thorough NP/PA. Same goes for anesthesia/CRNA. I’ve seen what a thoughtful primary or IM or anesthesia doc can contribute to patient care, and they’re truly higher quality but unfortunately we are often rushed or cut corners and end up indistinguishable from PA/NP.

 

[DO2015CA]

Honestly at some level I'm glad people don't because if everyone thought like me I'd be absolutely screwed. I thank god for all the primary care, peds, and surgery hopefuls

Lol primary care is the one I’m referring to with job market and life style. Idc about monetary, when I said life style I mean hours worked and call

 

[Oedipa Maas]

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.

I will say that while workup should include those things, I have rotated on a primary service at a hospital that has APPs in person and tele-attendings in the ER overnight and it was such a mess. All of their notes are documented that an attending was available by phone for the encounter but the actual required notes the attendings have to approve are very low so none of them were staffed by the time they got to us. There was one night where we got three chest pain admits. None of them had an EKG even ordered. And we are not talking costochondritis here. An immunocompromised patient with crackles on exam didn’t even have an attempt at a sepsis workup outside of a CBC. We had a patient with a foot ulcer that “didn’t look acutely infected” - there was active pus and I probed to bone - any imaging/wound cultures/blood cultures done? No. Patient with severe COPD exacerbation and possible STROKE was given multiple doses of Ativan before they were signed out to me because “they were anxious because they couldn’t breathe”. Sure so let’s add some respiratory depression to that. How can I do a neurological exam with someone that snowed?

It made me appreciate ER physicians so much, it was such a huge time suck trying to complete the insufficient workup (trying to add on labs, do studies on the floor that would be so much easier in the ER, figure out what was actually done, etc) on top of all the other stuff that comes with admissions and all the other things going on the floor. Sure there are algorithms but they do require someone competent to carry them out...

 

[Matthew9Thirtyfive]

I will say that while workup should include those things, I have rotated on a primary service at a hospital that has APPs in person and tele-attendings in the ER overnight and it was such a mess. All of their notes are documented that an attending was available by phone for the encounter but the actual required notes the attendings have to approve are very low so none of them were staffed by the time they got to us. There was one night where we got three chest pain admits. None of them had an EKG even ordered. And we are not talking costochondritis here. An immunocompromised patient with crackles on exam didn’t even have an attempt at a sepsis workup outside of a CBC. We had a patient with a foot ulcer that “didn’t look acutely infected” - there was active pus and I probed to bone - any imaging/wound cultures/blood cultures done? No. Patient with severe COPD exacerbation and possible STROKE was given multiple doses of Ativan before they were signed out to me because “they were anxious because they couldn’t breathe”. Sure so let’s add some respiratory depression to that. How can I do a neurological exam with someone that snowed?

It made me appreciate ER physicians so much, it was such a huge time suck trying to complete the insufficient workup (trying to add on labs, do studies on the floor that would be so much easier in the ER, figure out what was actually done, etc) on top of all the other stuff that comes with admissions and all the other things going on the floor. Sure there are algorithms but they do require someone competent to carry them out...

But yes, they provide equivalent care and we are overtrained. Please.

 

[SurfingDoctor]

I find the comparison to Rad/Onc a little disingenuous.

The number of patients who I've treated who needed a breathing tube or an emergent IV fluid bolus is too many to count. The number of patients who I've treated who needed a laser beam of radiation... I could count on 1 hand. Just for some perspective.

 

[Lawpy]

I find the comparison to Rad/Onc a little disingenuous.

The number of patients who I've treated who needed a breathing tube or an emergent IV fluid bolus is too many to count. The number of patients who I've treated who needed a laser beam of radiation... I could count on 1 hand. Just for some perspective.

The comparisons were about the job market oversaturation though?

EM being more critically important than radonc is known, so if anything the EM oversaturation actually looks worse because we can't have unemployed EM doctors who could've provided vital care if they had jobs

 

[SurfingDoctor]

The comparisons were about the job market oversaturation though?

EM being more critically important than radonc is known, so if anything the EM oversaturation actually looks worse because we can't have unemployed EM doctors who could've provided vital care if they had jobs

I understand that. The market forces are very different though.

That being said, essentially every hospital-based specialty is susceptible to over saturation because there are a finite number of jobs available.

 

[Matthew9Thirtyfive]

I understand that. The market forces are very different though.

And yet many EM grads are having lots of difficulty finding jobs now, and as shown above, there is predicted to be a huge difference in grads and jobs.

 

[Rekt]

I find the comparison to Rad/Onc a little disingenuous.

The number of patients who I've treated who needed a breathing tube or an emergent IV fluid bolus is too many to count. The number of patients who I've treated who needed a laser beam of radiation... I could count on 1 hand. Just for some perspective.

Aren't you also peds....? I'd expect your touches on rad pts to be very low.

All completely besides the point. The EM WILL be worse than rad onc in less than five years.

 

[SurfingDoctor]

Aren't you also peds....? I'd expect your touches on rad pts to be very low.

All completely besides the point. The EM WILL be worse than rad onc in less than five years.

I suppose to you mark this post and see 5 years down the road how it works out.

 

[SurfingDoctor]

And yet many EM grads are having lots of difficulty finding jobs now, and as shown above, there is predicted to be a huge difference in grads and jobs.

Many places have had hiring freezes in 2020. That’s not specific to EM.

 

[7331poas]

I find the comparison to Rad/Onc a little disingenuous.

The number of patients who I've treated who needed a breathing tube or an emergent IV fluid bolus is too many to count. The number of patients who I've treated who needed a laser beam of radiation... I could count on 1 hand. Just for some perspective.

What does that have to do with anything? They both rely on supply and demand. The only difference is that rad onc's supply and demand is much smaller.

 

[Matthew9Thirtyfive]

Many places have had hiring freezes in 2020. That’s not specific to EM.

What are you talking about? The issue is residency expansion, not hiring freezes.

 

[Rekt]

What are you talking about? The issue is residency expansion, not hiring freezes.

A peds icu doc blinded by the clouds in his academic tower telling the em resident that's in the midst looking for em jobs that the market is fine and it's just COVID.

Makes sense.

 

[SurfingDoctor]

What are you talking about? The issue is residency expansion, not hiring freezes.

But the "now" is affected by more than residency spots. There was a lot of healthcare contraction recently. Its really hard to look at the job market prospects in the future based on currently skewed numbers (if that's the numbers they are using... I admittedly didn't read the manuscript linked initially). If they are basing it on historical trends where the healthcare field wasn't impacted by a one off... then alright, maybe.

I mean, certainly one would hope they controlled for this confounder when predicting:

Hospitals continue to struggle with job losses as other areas of healthcare rebound in May

Hospitals lost 27,000 jobs in May, showing they have yet to recover financially.

www.healthcarefinancenews.com

Healthcare lost 30K jobs in January in first setback since pandemic hit

The industry has posted consistent monthly gains since the first months of the crisis, a run that ended last month, new data out Friday shows.

www.healthcaredive.com

But, I'll let people get back to their doom and gloom.

Edit: I was just curious and read the slides of the webinar. They blame several factors including the process being accelerated by COVID. Still seems like something that is hard to adjust for in prediction especially when they were basing their data on the past two years. Anyway...

 

[SurfingDoctor]

A peds icu doc blinded by the clouds in his academic tower telling the em resident that's in the midst looking for em jobs that the market is fine and it's just COVID.

Makes sense.

I never said anything was fine, just that the comparison to Rad/Onc isn't valid because the market forces are different.

But I also said in general, there is a trend (or at least the ability to have a trend) toward oversaturation in many hospital-based specialties. The reasons for that are pretty obvious and probably do need some reduction in residency/fellowship spots across the board (not just for EM by the way). That, coupled with reimbursement that provided more favor to preventative care and less to reactive care would probably shift the dynamics. But well, who knows if that will actually happen. Probably not anytime soon, cause freedom 'n stuff.

And yes... my tower is so high... they provide canned oxygen just so we can generate enough RVUs...

 

[Oo Cipher oO]

An unfortunate weakness of EM is the reliance on healthcare infrastructure. You basically have to work at an emergency department. Unlike IM, Peds, FM, etc there is little outpatient or private practice opportunities. EM may have to do a fellowship just to have marketable skills outside the ED and those jobs usually come at a substantial income loss.

I hope EM leaders can make the required changes but I never bet against the money and right now the big money is trying to pump out as much EM docs and mid level replacements as possible.

 

[QuentinT88]

An unfortunate weakness of EM is the reliance on healthcare infrastructure. You basically have to work at an emergency department. Unlike IM, Peds, FM, etc there is little outpatient or private practice opportunities. EM may have to do a fellowship just to have marketable skills outside the ED and those jobs usually come at a substantial income loss.

I hope EM leaders can make the required changes but I never bet against the money and right now the big money is trying to pump out as much EM docs and mid level replacements as possible.

100%.

As a recently matched PGY-1 in EM, its crazy how i'm just now starting to come to this realization. i can't believe it took this news for the truth to come out. And I agree that there should have been more transparency around the demand/supply in this field. This info would have been GREAT a few months ago when I could have applied to other fields knowing the state EM was in [absent from COVID issues]. I feel duped.

Current MS3's and new MS4's applying to this years match should be warned unlike my class.

 

[Matthew9Thirtyfive]

But the "now" is affected by more than residency spots. There was a lot of healthcare contraction recently. Its really hard to look at the job market prospects in the future based on currently skewed numbers (if that's the numbers they are using... I admittedly didn't read the manuscript linked initially). If they are basing it on historical trends where the healthcare field wasn't impacted by a one off... then alright, maybe.

I mean, certainly one would hope they controlled for this confounder when predicting:

I mean you are correct here. I think what people are saying is that it doesn’t really matter because even after you control for that stuff, the residency expansion problem is crushing the job market long term.

 

[The Knife & Gun Club]

100%.

As a recently matched PGY-1 in EM, its crazy how i'm just now starting to come to this realization. i can't believe it took this news for the truth to come out. And I agree that there should have been more transparency around the demand/supply in this field. This info would have been GREAT a few months ago when I could have applied to other fields knowing the state EM was in [absent from COVID issues]. I feel duped.

Current MS3's and new MS4's applying to this years match should be warned unlike my class.

You’re still in medical school, start the Re-app process now. Seriously. You can get letters in the next couple months, apply for eras next September, and go for it. Do IM, they’ll give you 6 months of credit for EM intern year most places.

Seriously, there’s nothing left in EM anymore. It’s not a career. You can’t have kids or own a home or have a working spouse when at any moment your job can get eliminated (or replaced by a dirt cheap new grad or NP) by a corporate overlord and there won’t be another job open in 300 miles in any direction.

The lies told earlier in the decade about EM has destroyed peoples lives/livelihoods.

 

[The Knife & Gun Club]

My old med school has eliminated the mandatory EM clerkship entirely. You want a letter? Gotta set it up as an elective.

“It’s no longer a viable career choice” according to the deans.

 

[Lawpy]

My old med school has eliminated the mandatory EM clerkship entirely. You want a letter? Gotta set it up as an elective.

“It’s no longer a viable career choice” according to the deans.

Wow. That. Is depressing.

 

[deleted966164]

Yikes... I guess... bye bye EM.

 

[QuentinT88]

My old med school has eliminated the mandatory EM clerkship entirely. You want a letter? Gotta set it up as an elective.

“It’s no longer a viable career choice” according to the deans.

What medical school, if you don't mind sharing?

 

[Lem0nz]

Wow. That. Is depressing pragmatic.

 

[QuentinT88]

You’re still in medical school, start the Re-app process now. Seriously. You can get letters in the next couple months, apply for eras next September, and go for it. Do IM, they’ll give you 6 months of credit for EM intern year most places.

Seriously, there’s nothing left in EM anymore. It’s not a career. You can’t have kids or own a home or have a working spouse when at any moment your job can get eliminated (or replaced by a dirt cheap new grad or NP) by a corporate overlord and there won’t be another job open in 300 miles in any direction.

The lies told earlier in the decade about EM has destroyed peoples lives/livelihoods.

You mean to re-apply again this cycle/year? [as in this upcoming September]. I'm seriously considering doing this honestly. I hate to give in to the pessimism, but its looking more and more like the writing is on the wall here. But I also know there will be a ton of hoops and hurdles to go through explaining this to my brand new PD....ugh

 

[Kracin]

It's interesting that on twitter, it's non-stop discussion about doctor shortages and a need for rapid residency expansion. Namely, this conversation is driven by premeds and medical students, usually targeting the AAMC or USMLE for making the process restrictive.

Then you get on SDN and get an entirely different view about residency expansion

 

[Lawpy]

It's interesting that on twitter, it's non-stop discussion about doctor shortages and a need for rapid residency expansion. Namely, this conversation is driven by premeds and medical students, usually targeting the AAMC or USMLE for making the process restrictive.

Then you get on SDN and get an entirely different view about residency expansion

Who cares what premeds think? They're busy trying to virtue signal adcoms by displaying their delusions for the world to see.

Med students are also delusional until clinical years strike them with a dose of reality

Also Twitter is a dumpster fire overrun by trolls and bots.

 

[Lem0nz]

It's interesting that on twitter, it's non-stop discussion about doctor shortages and a need for rapid residency expansion. Namely, this conversation is driven by premeds and medical students, usually targeting the AAMC or USMLE for making the process restrictive.

Then you get on SDN and get an entirely different view about residency expansion

This is why I usually go to town on the anti-midlevel crowd made up of medical students and younger residents. The perceived threats vs. the actual threats are quite different as you get older. Perspective is very important, and often lacking. Reddit even more of a tire fire. Tons of fun, 10/10, would recommend.

 

[Lawpy]

This is why I usually go to town on the anti-midlevel crowd made up of medical students and younger residents. The perceived threats vs. the actual threats are quite different as you get older. Perspective is very important, and often lacking. Reddit even more of a tire fire. Tons of fun, 10/10, would recommend.

Weren't you tired and frustrated after getting repeatedly dunked on in multiple midlevel discussions?

 

[Lem0nz]

Not really. At first I was when I first started using Reddit but I got over it quickly once I found other people near graduation or attendings who were voices of reason. The common denominator tends to be level of training. The further along you get the more you realize that you have to understand healthcare is a business, no matter how you slice it. The first time someone was like "you're a **** surgeon because you use a PA" I got super fired up. Now I'm like "kid... kiddddddddd. You're going to have a real rough life when you start trying to work for money instead of for honor." Here people are way more reasonable and can have a conversation. Except Steve, but he's w/e. That kids got anger issues.

 

[Steve_Zissou]

Not really. At first I was when I first started using Reddit but I got over it quickly once I found other people near graduation or attendings who were voices of reason. The common denominator tends to be level of training. The further along you get the more you realize that you have to understand healthcare is a business, no matter how you slice it. The first time someone was like "you're a **** surgeon because you use a PA" I got super fired up. Now I'm like "kid... kiddddddddd. You're going to have a real rough life when you start trying to work for money instead of for honor." Here people are way more reasonable and can have a conversation. Except Steve, but he's w/e. That kids got anger issues.

Eh, not really, just a low opinion of you and the supervisory form of medicine you like.

Edit: also gotta point out that you've had, what, maybe one interaction with me? If you read my posts as me being angry, that's on you. Lots of time in the SPF has probably made my forum communication more blunt/abrasive though.

 

[SurfingDoctor]

Eh, not really, just a low opinion of you and the supervisory form of medicine you like.

Edit: also gotta point out that you've had, what, maybe one interaction with me? If you read my posts as me being angry, that's on you. Lots of time in the SPF has probably made my forum communication more blunt/abrasive though.

 

[Zen Arcade]

Eh, not really, just a low opinion of you and the supervisory form of medicine you like.

Edit: also gotta point out that you've had, what, maybe one interaction with me? If you read my posts as me being angry, that's on you. Lots of time in the SPF has probably made my forum communication more blunt/abrasive though.

Gonna have to side with Steve on this one. Lem0nz gives me pre-boomer doc vibes.

 

[Redpancreas]

You’re still in medical school, start the Re-app process now. Seriously. You can get letters in the next couple months, apply for eras next September, and go for it. Do IM, they’ll give you 6 months of credit for EM intern year most places.

Seriously, there’s nothing left in EM anymore. It’s not a career. You can’t have kids or own a home or have a working spouse when at any moment your job can get eliminated (or replaced by a dirt cheap new grad or NP) by a corporate overlord and there won’t be another job open in 300 miles in any direction.

The lies told earlier in the decade about EM has destroyed peoples lives/livelihoods.

That's a hell of a move there and should not be taken lightly. You will be seen as a red flag/lesser applicant (whatever term you want to use) if you do this regardless of whether you were an amazing EM resident or had great stats in med school. Not being in the graduating class of the one currently being recruited puts you in a separate pile.

 

[Redpancreas]

Gonna have to side with Steve on this one. Lem0nz gives me pre-boomer doc vibes.

Since you stated your side explicitly, I'll provide a counterweight and say I absolutely side with @Lem0nz in this instance (with the exception of him calling out Steve personally as I like a majority of @Steve_Zissou 's perspectives too except when it comes to many midlevel discussions - but even there we agree sometimes).

 

[DOVinciRobot]

Within 2 years EM will be an IMG/FMG/DO wasteland. Med students aren’t stupid. The mass exodus from EM has already begun, and I personally know EM residents who have secured positions in different specialties.

This isn’t like rad onc or path IMO. There is a real chance we are witnessing first stages of the demise of the entire specialty. PE/CMGs and rapid residency expansion have killed it.

 

[Steve_Zissou]

Since you stated your side explicitly, I'll provide a counterweight and say I absolutely side with @Lem0nz in this instance (with the exception of him calling out Steve personally as I like a majority of @Steve_Zissou 's perspectives too except when it comes to many midlevel discussions - but even there we agree sometimes).

Honestly was confused I got called out lol

 

[Redpancreas]

Honestly was confused I got called out lol

I vaguely remember a midlevel thread where it was me and @Lem0nz arguing midlevels are omnipresent and a necessary reality in medicine. You, ?Sunshinefl, and maybe someone else argued against our posts and @Lawpy was basically summarizing everyone's points. Whenever I see your name I automatically think back to that. I obviously disagree with your opinion there but life's nuanced and I still think you're posts are solid even if I disagree with some opinions.

----

Anyways there seems to be an alarmist sentiment in this thread. I remember the 2016-2018 days where EM was on fire on these forums. Like every third post was asking about something EM specific, there were tons of EM vs. X discussions. Heck...even I as someone who always had IM-> fellowship in mind since high school considered EM for a few hot seconds. Now there seems to be some a lot of concern. I am not sure exactly what besides some rumblings about CMGs and this ACEP meeting last Friday has got everyone in such a panic about EM. I just find it very difficult to believe that a field that so many good students is going to struggle to the extent that many may not be able to find a job?! Maybe the average salary will be more down to earth (200K) which makes sense as PCPs/Internists make that much after 3 years of fellowship and EM doesn't have the continuity IM has, but at the end of the day we all chose to do what we wanted ultimately because we primarily liked it.

 

[Steve_Zissou]

I vaguely remember a midlevel thread where it was me and @Lem0nz arguing midlevels are omnipresent and a necessary reality in medicine. You, ?Sunshinefl, and maybe someone else argued against our posts and @Lawpy was basically summarizing everyone's points. Whenever I see your name I automatically think back to that. I obviously disagree with your opinion there but life's nuanced and I still think you're posts are solid even if I disagree with some opinions.

I appreciate it. There are few posters that I hold negative personal feelings against, and plenty who I disagree with and would consider digital friends. Lots in the SPF too like @SurfingDoctor

 

[The Knife & Gun Club]

That's a hell of a move there and should not be taken lightly. You will be seen as a red flag/lesser applicant (whatever term you want to use) if you do this regardless of whether you were an amazing EM resident or had great stats in med school. Not being in the graduating class of the one currently being recruited puts you in a separate pile.

I mean what’s the alternative? There’s plenty of programs that will be happy to take someone who’s clinically skilled. And will work hard and learn whatever other field they chose.

There is literally no point in completing an EM residency at this point. It’s a valueless board certification as it no longer confers meaningful career prospects.

I’d be jumping ship myself at this point except at the end of PGY1 now it’s faster to finish and do crit or pain or sports than it is to go back and start again.

Edit: to be clear I mean valueless from a med student prospective. I think what myself and my colleagues have done during the pandemic and the skills we possess have incredible value to society. Just valueless in the sense that you can no longer pay off debt or have a reliably stable career with just EM boards.

 

[QuentinT88]

I mean what’s the alternative? There’s plenty of programs that will be happy to take someone who’s clinically skilled. And will work hard and learn whatever other field they chose.

There is literally no point in completing an EM residency at this point. It’s a valueless board certification as it no longer confers meaningful career prospects.

I’d be jumping ship myself at this point except at the end of PGY1 now it’s faster to finish and do crit or pain or sports than it is to go back and start again.

Yeah i have a meeting set up with an advisor at my school for later this week and I will explore all options about re-applying to the match vs finishing up in EM.

The only thing that i'm realizing though is that doing a fellowship in CC, pain or sports medicine just got significantly more competitive, as a lot of current EM residents across the country will be looking into these options after the ACEP report...

 

[The Knife & Gun Club]

Yeah i have a meeting set up with an advisor at my school for later this week and I will explore all options about re-applying to the match vs finishing up in EM.

The only thing that i'm realizing though is that doing a fellowship in CC, pain or sports medicine just got significantly more competitive, as a lot of current EM residents across the country will be looking into these options after the ACEP report...

Yea we’re going to see a lot of EM refugees in the next few years end up in funky places.

Our hospitals PMR program recently opened up a fellowship to the EM grads where they can learn how to do post-spinal cord injury care in quads and paras. Has like NO relation to EM training but there’s jobs in the field, technically can do it with any board certified, so I’m sure it’ll fill.

 

[ace_inhibitor111]

I vaguely remember a midlevel thread where it was me and @Lem0nz arguing midlevels are omnipresent and a necessary reality in medicine. You, ?Sunshinefl, and maybe someone else argued against our posts and @Lawpy was basically summarizing everyone's points. Whenever I see your name I automatically think back to that. I obviously disagree with your opinion there but life's nuanced and I still think you're posts are solid even if I disagree with some opinions.

----

Anyways there seems to be an alarmist sentiment in this thread. I remember the 2016-2018 days where EM was on fire on these forums. Like every third post was asking about something EM specific, there were tons of EM vs. X discussions. Heck...even I as someone who always had IM-> fellowship in mind since high school considered EM for a few hot seconds. Now there seems to be some a lot of concern. I am not sure exactly what besides some rumblings about CMGs and this ACEP meeting last Friday has got everyone in such a panic about EM. I just find it very difficult to believe that a field that so many good students is going to struggle to the extent that many may not be able to find a job?! Maybe the average salary will be more down to earth (200K) which makes sense as PCPs/Internists make that much after 3 years of fellowship and EM doesn't have the continuity IM has, but at the end of the day we all chose to do what we wanted ultimately because we primarily liked it.

People have already noticed future problems with EM residency hyperexpansion even back in 2016-2018 when the job market was still good. This was brushed off as doom and gloom. The COVID outbreak accelerated the issue by reducing demand by 20%, and now we can see the future effects of the oversupply as EM residents had trouble finding jobs. This forced EM organizations to actually look at the numbers. AAEM already sent out warnings over the past year about the issue but not too many people listened. It was only until ACEP drew attention to the data that people realize what is happening and are panicking. It has been a longstanding problem even before the panic.