Decline of EM

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scoopdaboop said:
EM isn't dying. People overreacting. There's like 3x as many FM residencies than EM right now, they're not suffering for any jobs.
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Lol because they aren't hospital based? Do you know the ridiculous number of clinics that exist? Very few emergency departments in comparison
 
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cyanide12345678 said:
Lol because they aren't hospital based? Do you know the ridiculous number of clinics that exist? Very few emergency departments in comparison
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EM is also a 24/7 job unlike FM. There's literally thousands of jobs everywhere on job boards still.
 
scoopdaboop said:
EM isn't dying. People overreacting. There's like 3x as many FM residencies than EM right now, they're not suffering for any jobs.
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Are you trolling?

EM is dying. Not even a slow death. You do not know how good it was if you didn't experience it. Glad I paid off my loans during the golden age.
 
Rekt said:
Fairytale land right here. PCPs either have built in EM or posthospital follow up or they can slot them in fairly quickly. I used to call all the time for patients to get follow up and never had issues getting fast appointments before the little life force I had left was sapped from my body. Yeah it's definitely a huge waste but also the reason you get to go on several vacations a year and/or your kids go to the best school.

As Rustedfox says, patients are the worst part of medicine.
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My ED follow up appointment no show rate is over 50%...
 
It's very true that we are employed and make money due to non-emergencies and urgencies.

RF and I have both pointed out that what annoys us most is patients who PRESENT FOR THINGS THAT NEED NO MEDICAL CARE.

Previous generations of humans could somehow manage simple bumps, scrapes, sprains, colds, and minor pains at home without seeking medical care. For some reason humans now are incapable of caring for the slightest medical issue themselves. These *****s present to the ED "cuz it's free" and convenient for them to do so. Yes they keep us employed, but they are also one of the drivers of runaway medical costs that is going to result in a single payer system in my lifetime.
 
An alternate prediction of the future:

•Supply of EM physicians expands.
•Then they build more ERs.
•Then, due to increased availability, patients flood to these ERs causing demand for EM physician services to increase at same pace as supply.
•This in turn causes EM physician hours and wages to, unexpectedly, not fall and instead keep pace with other medical specialties.

How plausible?
 
scoopdaboop said:
EM is also a 24/7 job unlike FM. There's literally thousands of jobs everywhere on job boards still.
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Do you think that you have a better grasp on this than the EM physicians that are telling you the opposite of what you are saying?
What do you make of the (long apparent but recently publicized) 9k EM oversupply by 2030?
What do you make of the decreased locums positions in the last 5 years?
What do you make of the continued adoption of midlevels in EM?
What do you make of the private equity funded residencies in EM?

And as another poster mentioned, how can you possibly think it is reasonable to equate primary care physicians, who can work in a ton of different settings, with EM physicians, who can work in relatively few settings? The total number of physicians in a specialty is only important in the context of the total demand for that specialty. EM has less demand than primary care doctors.

And to address a thought I hear from people like you sometimes, that "EM physicians will still be paid a lot regardless"- well, maybe. But when you look at how much they're bringing in for the hospital compared with their (likely to decline) salaries, corporations are increasingly profiting from their work. That's wrong, and it speaks to the lack of EM physician power. It also makes EM less viable/less responsible of a career choice in the context of increasing student debt.
 
Cath Up said:
Do you think that you have a better grasp on this than the EM physicians that are telling you the opposite of what you are saying?
What do you make of the (long apparent but recently publicized) 9k EM oversupply by 2030?
What do you make of the decreased locums positions in the last 5 years?
What do you make of the continued adoption of midlevels in EM?
What do you make of the private equity funded residencies in EM?

And as another poster mentioned, how can you possibly think it is reasonable to equate primary care physicians, who can work in a ton of different settings, with EM physicians, who can work in relatively few settings? The total number of physicians in a specialty is only important in the context of the total demand for that specialty. EM has less demand than primary care doctors.

And to address a thought I hear from people like you sometimes, that "EM physicians will still be paid a lot regardless"- well, maybe. But when you look at how much they're bringing in for the hospital compared with their (likely to decline) salaries, corporations are increasingly profiting from their work. That's wrong, and it speaks to the lack of EM physician power. It also makes EM less viable/less responsible of a career choice in the context of increasing student debt.
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I've always said that the thing which would wake up EM docs, is to have the third party CMG who's actually collecting the bills publish every year how much they actually collect by billing in each doctor's name. If they are collecting $700K using my license, but only paying $300K that's a problem and I think most would find it unacceptable. ACEP should push for this if they truly represent EM physicians.
 
GeneralVeers said:
It's very true that we are employed and make money due to non-emergencies and urgencies.

RF and I have both pointed out that what annoys us most is patients who PRESENT FOR THINGS THAT NEED NO MEDICAL CARE.

Previous generations of humans could somehow manage simple bumps, scrapes, sprains, colds, and minor pains at home without seeking medical care. For some reason humans now are incapable of caring for the slightest medical issue themselves. These *****s present to the ED "cuz it's free" and convenient for them to do so. Yes they keep us employed, but they are also one of the drivers of runaway medical costs that is going to result in a single payer system in my lifetime.
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I have cared for an unsettling number of men in their 30s and 40s who were brought to the ER by their mommies for viral syndromes.

What's more unsettling is that they give no indication that they think that this is abnormal behavior.

You said it best when you said: "Americans are beyond hope."
 
Birdstrike said:
An alternate prediction of the future:

•Supply of EM physicians expands.
•Then they build more ERs.
•Then, due to increased availability, patients flood to these ERs causing demand for EM physician services to increase at same pace as supply.
•This in turn causes EM physician hours and wages to, unexpectedly, not fall and instead keep pace with other medical specialties.

How plausible?
Click to expand...

Somewhat...can kind of see this happen in the sticks, but most urban/suburban areas are saturated with hospitals. Houston methodist (yes the same one involved in the lawsuit) is building a new hospital in the northwest part of town as we speak, but don't know if others will follow suit.
 
RustedFox said:
The number one problem with medicine is...
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On an overnight shift and just got threatened with violence because I refused to give more dilaudid to a sickler less than 30 minutes after he already got 2g IV dilaudid. Hg 10, vitals normal. No acute crisis. Fun times.
 
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bravotwozero said:
On an overnight shift and just got threatened with violence because I refused to give more dilaudid to sickler less than 30 minutes after he already got 2g IV dilaudid. Hg 10, vitals normal. No acute crisis. Fun times.
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Hemoglobin of 10 prob isn't really a sickler. Probably one of the Trait-Seekers.
 
Birdstrike said:
An alternate prediction of the future:

•Supply of EM physicians expands.
•Then they build more ERs.
•Then, due to increased availability, patients flood to these ERs causing demand for EM physician services to increase at same pace as supply.
•This in turn causes EM physician hours and wages to, unexpectedly, not fall and instead keep pace with other medical specialties.

How plausible?
Click to expand...

You know, stranger things have happened.

It's too bad that we have no unified, pragmatic body within medicine to help address the EP oversupply. Can we contract with the Screen Actors Guild to set up a physician equivalent??

Given this vacuum of national physician representation and decision-making power, I wonder if the government will step in. Having ~10k residency-trained physicians with nowhere to practice is a disaster on many levels and will further limit access to care. May be too juicy of an issue for politicians to pass up.
 
namethatsmell said:
It's too bad that we have no unified, pragmatic body within medicine to help address the EP oversupply. Can we contract with the Screen Actors Guild to set up a physician equivalent??
Click to expand...
It’s one of the greatest disappointments of my medical career, that we physicians as a group have done so little, almost nothing, to leverage our power and stand up for ourselves, as our profession has been taken over by people with little to no ethics, who have taken no oath.
 
Birdstrike said:
It’s one of the greatest disappointments of my medical career, that we physicians as a group have done so little, almost nothing, to leverage our power and stand up for ourselves, as our profession has been taken over by people with little to no ethics, who have taken no oath.
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Acep made a cute graph showing "possible" solutions to the oversupply. None of which included actually reducing the amount of residents or programs nor departing from their relationships with contract management corporations nor CMC program creation.

So glad for our "representation"
 
Birdstrike said:
An alternate prediction of the future:

•Supply of EM physicians expands.
•Then they build more ERs.
•Then, due to increased availability, patients flood to these ERs causing demand for EM physician services to increase at same pace as supply.
•This in turn causes EM physician hours and wages to, unexpectedly, not fall and instead keep pace with other medical specialties.

How plausible?
Click to expand...
As long as CMGs control the market, I don’t see improvement in things.

I think in your scenario, hours would maintain but pay (at least per hour) would fall. We would also transition into an ‘acute care medicine’ role, taking this over from primary care. We would own subacute msk and other medical urgencies, rather than referring them back to their pcp. Which honestly makes sense, why should I need to send a pt back to FM for a PT referral?


GeneralVeers said:
ACEP should push for this if they truly represent EM physicians.
Click to expand...
They don’t, they represent CMGs. That’s the problem.
 
bravotwozero said:
On an overnight shift and just got threatened with violence because I refused to give more dilaudid to a sickler less than 30 minutes after he already got 2g IV dilaudid. Hg 10, vitals normal. No acute crisis. Fun times.
Click to expand...

I've been punched a few times on shift.
 
Apollyon said:
Did you have them arrested?
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No.

One was bath salts guy who was so far out of it that he must have thought I was a demon or something.

One was 17 year old girl who got me right in the jaw after I broke her pseudoseizure.

One was old man; punched me during an ortho reduction.
 
Apollyon said:
Did you have them arrested?
Click to expand...

Your hospitals might be better than the places I've worked. But can't imagine pressing the issue.

Police: "the patient was intoxicated and in distress"..."we can't charge him" (i.e. this would suck for me to pursue, you're on your own).
Admin: "this is bad PR"..."you should use better communication skills with patients, here's some remedial training" (i.e. it's your fault).
CMG: "this is threatening our contract" (suck it up).

People threaten to hit me, kill me, kill others, kill themselves, and sue me. I must have missed that lecture medical school.
 
RustedFox said:
No.

One was bath salts guy who was so far out of it that he must have thought I was a demon or something.

One was 17 year old girl who got me right in the jaw after I broke her pseudoseizure.

One was old man; punched me during an ortho reduction.
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I was a resident during the worst of the balt salts craze, that stuff was just awful from the doctor end.
 
Birdstrike said:
It’s one of the greatest disappointments of my medical career, that we physicians as a group have done so little, almost nothing, to leverage our power and stand up for ourselves, as our profession has been taken over by people with little to no ethics, who have taken no oath.
Click to expand...
A modern day tragedy. I want us to unite.
 
MechEDoc said:
Your hospitals might be better than the places I've worked. But can't imagine pressing the issue.

Police: "the patient was intoxicated and in distress"..."we can't charge him" (i.e. this would suck for me to pursue, you're on your own).
Admin: "this is bad PR"..."you should use better communication skills with patients, here's some remedial training" (i.e. it's your fault).
CMG: "this is threatening our contract" (suck it up).

People threaten to hit me, kill me, kill others, kill themselves, and sue me. I must have missed that lecture medical school.
Click to expand...

Had a patient recently that said he was leaving the department to get a gun and come back and kill everyone in the ED.

The cops did nothing at all.
 
RustedFox said:
No.

One was bath salts guy who was so far out of it that he must have thought I was a demon or something.

One was 17 year old girl who got me right in the jaw after I broke her pseudoseizure.

One was old man; punched me during an ortho reduction.
Click to expand...
I know a pseudoseizure who punched a doc. He got 100 of rocuronium for his "status epilepticus" and spent the night in ICU on a midazolam drip with continuous EEG monitoring. Oops, forgot the etomidate. Guess who was extubated the next day and went home with an EEG showing no seizure activity.
 
Rekt said:
Had a patient recently that said he was leaving the department to get a gun and come back and kill everyone in the ED.

The cops did nothing at all.
Click to expand...

Had the cops drop off a drunk (who had no medical problems), this huge native dude started tearing our small ER to pieces. Just myself and maybe three female nurses. The cops WOULD NOT RETURN to assist. Wound up calling 911 and stating that we needed an emergency response as we were going to evacuate the ER. Pretty much the whole department and mutual aid came code 3. We were still stuck with that drunk a-hole, but at least this time he was in a k-hole.

Calling the cops isn't that useful 🙁.



That kiddo at 2:27? Almost had him as a patient. 2:38? Some other cop in the "51st smartest state" tried that on me as well, I didn't fall for it. Pretty sure that cop was lying. No idea why.

More that once some a-hole cop has lied about patients they've dropped off. Heck, a "law enforcement officer" even assaulted an AMA patient in the hospital parking lot, hog tied him, and then brought him back for more care! The patient's offense? Being drunk and native American. I'm polite and professional, but trust the cops to be honest just as much as any other patient history. It's saved both myself and patients a lot of heartache.

That being said, I usually love having off duty cops for ER security instead of some some hospital hired mall cop. Cops get qualified immunity and get to act outside of "medical treatment". Want to taser a patient? I'll try to be blissfully unaware until the dust settles. Most hospital security guards are actively worse than useless.
 
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scoopdaboop said:
EM is also a 24/7 job unlike FM. There's literally thousands of jobs everywhere on job boards still.
Click to expand...

Thousands of jobs 😂😂😂😂😂😂😂😂😂 sure. Are you an attending physician? If you're not then please don't misguide people if you've never looked for a job in emergency medicine in the last 1 year.
 
Rekt said:
Had a patient recently that said he was leaving the department to get a gun and come back and kill everyone in the ED.

The cops did nothing at all.
Click to expand...

I've never understood why "Homicidal Ideation" people are put on legal holds and brought to the ER. They should be in jail for the protection of everyone and get appropriate mental health screening in a secure environment.
 
MechEDoc said:
Your hospitals might be better than the places I've worked. But can't imagine pressing the issue.

Police: "the patient was intoxicated and in distress"..."we can't charge him" (i.e. this would suck for me to pursue, you're on your own).
Admin: "this is bad PR"..."you should use better communication skills with patients, here's some remedial training" (i.e. it's your fault).
CMG: "this is threatening our contract" (suck it up).

People threaten to hit me, kill me, kill others, kill themselves, and sue me. I must have missed that lecture medical school.
Click to expand...

A CMG minion told me the same thing after a patient hit staff and threatened to kill me. $h*t like this is reason #809 why CMGs are evil. You are essentially the only cog in their money machine that makes it go...yet they devalue your existence whenever possible (and by extension they encourage others to do so). The constant gaslighting from these jokers is insufferable. If somebody strolled into CMG headquarters and struck somebody you'd think they'd a) suck it up or b) call the police? At the end of the day, your well-being will never be more important than the $$$ you can generate for them.

This is one of many reasons I've found direct non-profit hospital employment to be far better than CMG gigs. Not only have I never heard the "we could lose the contract" bull$h*t, but as a direct employee you tend to have much better employment protections/rights. Case in point, one hospital I used to work at had solid security but there were still occasional issues of staff being assaulted by patients. One of the ways they responded was to hire a group to teach us all how to strike patients in the event we had to. And afterwards the hospital admin re-iterated many times over that it was completely acceptable to hit patients to protect ourselves in these rare situations. Oh, and how'd they handle patients who threatened staff? Almost always got reported to the police (unless staff didn't want to) and there was a running list of patients not allowed on hospital grounds unless there was legit concern of emergent condition in which case they'd have an MSE in triage with probable d/c from there. It was so d*mn refreshing...yet sad that it was refreshing in the first place.
 
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Rekt said:
Had a patient recently that said he was leaving the department to get a gun and come back and kill everyone in the ED.

The cops did nothing at all.
Click to expand...

Sensing a pattern here. One of my attendings, who was a former cop, had to take down a patient that had been D/C'd and got violent in the waiting room. They grabbed one of the poles used to mark the entry and exit pathways, broke a door with it and was swinging it at patients and staff. Security was useless as usual. PD shows up and says "Well, we didn't see it, so we can't arrest him." They refused to look at the security cam footage. They had to be convinced to even escort them off the hospital grounds
 
VA Hopeful Dr said:
I wish it was that simple.

Every doctor in my office (9 of us) has large numbers of same day and work in appointment spots. I haven't completely filled my schedule more than once per week ever. So it's a combination of other factors: patients thinking something is more serious than it is, not wanting to wait until the availability appointment, not happy after they did see me about a problem, not wanting to pay a co pay. You get the idea.
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I understand it's complicated. And patients are told by PCP's, staff, nurses, just about everybody to "go to the ER". And we tell them "to go to their PCP". So patients are given the run around. I genuinely believe that 90% of the time it's a dump. It's not done because there is a genuine belief they need emergency care.
 
thegenius said:
I understand it's complicated. And patients are told by PCP's, staff, nurses, just about everybody to "go to the ER". And we tell them "to go to their PCP". So patients are given the run around. I genuinely believe that 90% of the time it's a dump. It's not done because there is a genuine belief they need emergency care.
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Probably a lot of variability there. I know my staff has some problems that if a patient calls in with they are required to suggest going to the ED. But, if the patient refuses they will schedule them with me.
 
thegenius said:
I understand it's complicated. And patients are told by PCP's, staff, nurses, just about everybody to "go to the ER". And we tell them "to go to their PCP". So patients are given the run around. I genuinely believe that 90% of the time it's a dump. It's not done because there is a genuine belief they need emergency care.
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" I called my DOCTOR and he said come to the ER straight away".
 
Having a lot of our PMDs being the same Epic instance and me being able to see their mychart messages and telephone encounters, patients also like to exaggerate insanely or selectively leave out information to their PMD that result in their ED referral.

"My BP is so high today!"
"Oh okay...we'll schedule you ..."
"Now, I'm having a SEVERE headache, and I'm dizzy, vision is blurred, my fingers are tingling. It's making me feel short of breath."
"Uh....just to go to the ED."

"Why are you here in the ED?"
"My doctor sent me here for high blood pressure."
"Anything else?"
"No"
 
pkwraith said:
Having a lot of our PMDs being the same Epic instance and me being able to see their mychart messages and telephone encounters, patients also like to exaggerate insanely or selectively leave out information to their PMD that result in their ED referral.

"My BP is so high today!"
"Oh okay...we'll schedule you ..."
"Now, I'm having a SEVERE headache, and I'm dizzy, vision is blurred, my fingers are tingling. It's making me feel short of breath."
"Uh....just to go to the ED."

"Why are you here in the ED?"
"My doctor sent me here for high blood pressure."
"Anything else?"
"No"
Click to expand...
And of course when you send that asymptomatic hypertension home without addressing those complaints because the ED was jam packed and you didn’t read the communication, guess who will be on the hook if that patient has any adverse outcome over the next few weeks?

Lawyer: It says in the chart right here, DOCTOR, that they were having hypertensive emergency! You were negligent to not treat that before this (absurdly sick at baseline) patient had his hemorrhagic stroke 10 days later….no I don’t care what the patient actually told you during the visit!
 
Patient calls nurse, "I need a refill on my butt cream. And I can't move my right leg. But it's always been that way. Or maybe it was the other leg? I can't remember. I need to see the doc for my butt cream. Please!"

Nurse: "We'll refill your cream at your next appointment. But if you're having sudden limb paralysis, you need to go to the ER immediately."

Patient in ED: "My doc sent me to ER for butt cream refill."

Having worked EM and now outpatient, I've learned that what the patient tells the ED upon arrival, is almost never an accurate representation of what has transpired.
 
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Birdstrike said:
Having worked EM and now outpatient, I've learned that what the patient tells the ED upon arrival, is almost never an accurate representation of what has transpired.
Click to expand...

Yes. This is the reason that what I write in my charts is almost never an accurate representation of what my ED patient has told me.
 
pkwraith said:
Having a lot of our PMDs being the same Epic instance and me being able to see their mychart messages and telephone encounters, patients also like to exaggerate insanely or selectively leave out information to their PMD that result in their ED referral.

"My BP is so high today!"
"Oh okay...we'll schedule you ..."
"Now, I'm having a SEVERE headache, and I'm dizzy, vision is blurred, my fingers are tingling. It's making me feel short of breath."
"Uh....just to go to the ED."

"Why are you here in the ED?"
"My doctor sent me here for high blood pressure."
"Anything else?"
"No"
Click to expand...

Birdstrike said:
Patient calls nurse, "I need a refill on my butt cream. And I can't move my right leg. But it's always been that way. Or maybe it was the other leg? I can't remember. I need to see the doc for my butt cream. Please!"

Nurse: "We'll refill your cream at your next appointment. But if you're having sudden limb paralysis, you need to go to the ER immediately."

Patient in ED: "My doc sent me to ER for butt cream refill."

Having worked EM and now outpatient, I've learned that what the patient tells the ED upon arrival, is almost never an accurate representation of what has transpired.
Click to expand...

... and the number one problem with medicine is ....


Oh wait, I used that once already this thread..
Carry on.
 
pkwraith said:
Having a lot of our PMDs being the same Epic instance and me being able to see their mychart messages and telephone encounters, patients also like to exaggerate insanely or selectively leave out information to their PMD that result in their ED referral.

"My BP is so high today!"
"Oh okay...we'll schedule you ..."
"Now, I'm having a SEVERE headache, and I'm dizzy, vision is blurred, my fingers are tingling. It's making me feel short of breath."
"Uh....just to go to the ED."

"Why are you here in the ED?"
"My doctor sent me here for high blood pressure."
"Anything else?"
"No"
Click to expand...

Yup this stuff happens all the time too.
 
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