EM Applicants Down 16% From One Year Ago, Residents and Programs Up

[2021Doctor]

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[Lexdiamondz]

Good.

That being said, many of those spots will end up being filled by desperate IMGs and FMGs. While deterring US students is important, the reality is these programmes need to close.

 

[AlmostAnMD]

That's true

the one pop-up program I know of at a site that absolutely doesn't need a residency is just cramming them with FMGs. Now in their second year of a program not one student graduating from the US has matched there. The trend will likely continue. It's terrible watching a flood and being unable to turn off the water supply

 

[miacomet]

We just received a bunch of resumes from pop residencies and for-profit med schools
Uh, we will not be hiring you, ever

 

[sylvanthus]

Ya not gonna matter, programs will still fill. Sickly entertaining to watch the demise of one of the newest specialties though. ACEP just had a big anniversary celebrating the specialty, what last year? Two years ago? Now were in a freefall.

 

[EctopicFetus]

As stated the only thing that matters are if we have more applicants than spots. If we do the slow death of em will continue.

 

[miacomet]

And we always will because of FMGs and IMGs.
Funny, the places I used to do locums, the VAs and even more so the IHS, have waitlists for applicants. It's wild.

 

[turkeyjerky]

And we always will because of FMGs and IMGs.
Funny, the places I used to do locums, the VAs and even more so the IHS, have waitlists for applicants. It's wild.

I've noticed recently that a fair number of CMGs have job postings for sites that I know to be fully staffed. Some of this might be from people retiring or leaving, but I suspect a large percentage is in order to purposefully overstaff, likely to facilitate firing "low performers". It makes the job market look better than it actually is.

 

[EctopicFetus]

I've noticed recently that a fair number of CMGs have job postings for sites that I know to be fully staffed. Some of this might be from people retiring or leaving, but I suspect a large percentage is in order to purposefully overstaff, likely to facilitate firing "low performers". It makes the job market look better than it actually is.

you are perhaps missing the best reason. Start with the premise that they exist to serve their shareholders / investors.
it’s actually to drive down the hourly rate.
doc a always works his 150 hours for 200/hr. High cost life, private school, new bmw and student loans. Guy saves only the 20k a year in retirement and even doing that is hard for him. Stay at home wife.
doc b works 100 hours a month she hates work and would rather be with her family. Recently divorced so there is some guilt related to kids. Also earns $200/hr. Doesnt live like a doc and is able to save 40-50k a year depending on working “bonus“ shifts.
they hire doc c a new grad who has 400k in debt willing to work like A dog. Trained at an hca residency and loves cheap shrimp and equally subpar booze. Still single doc c (no gender) wants to buy a cool condo and a nice car. Was told new pay rate is 180/hr due to some new law and insurers being bad.
quickly everyone in this scenario is working for 180. Rinse repeat and recycle. Doc a works more to maintain lifestyle, doc b hours stay the same and she saves less. Work is too unbearable. Doc c works 160 -180 hours a month cause “it’s still better than residency”.
CMGs win. Playbook written.

 

[Birdstrike]

Healthcare is a business. Like most businesses, it is not run by doctors. Don't ever think that those who are in charge, give one damn about what's best for doctors.

 

[lucid_leprechaun]

Healthcare is a business. Like most businesses, it is not run by doctors. Don't ever think that those who are in charge, give one damn about what's best for doctors.

Or patients. The administration only cares about what ends up in their pockets.

 

[EctopicFetus]

Or patients. The administration only cares about what ends up in their pockets.

I didnt understand this til I was a few years out of residency. Be it HCA, your local hospital system or some other non profit. This reality needs to be fully understood by the pre meds and med student types. This isnt medicine in 1975.

 

[thegenius]

Healthcare is a business. Like most businesses, it is not run by doctors. Don't ever think that those who are in charge, give one damn about what's best for doctors.

This is hyperbole. C'mon now.

 

[Rekt]

This is hyperbole. C'mon now.

You can't honestly think the C suite cares about you? The second they catch wind of something that makes them a couple more dollars at your expense, any expense, they'll do it. If you're in a CMG then the people that don't care about you are even closer.

 

[thegenius]

They care about having happy physicians working for them. Why would a hospital want to piss off every physician to make an extra dollar?

I understand the sentiment, they need to balance their budget, make some profit, etc. But comments like the one made makes it seem like C-suite admins sit around every day scheming ways to take more money from physicians to put it in their pockets. And that isn't happening. Every few years when contracts are re-negotiated both sides want favorable terms, but that is normal business.

 

[RustedFox]

They care about having happy physicians working for them. Why would a hospital want to piss off every physician to make an extra dollar?

I understand the sentiment, they need to balance their budget, make some profit, etc. But comments like the one made makes it seem like C-suite admins sit around every day scheming ways to take more money from physicians to put it in their pockets. And that isn't happening. Every few years when contracts are re-negotiated both sides want favorable terms, but that is normal business.

See: Sepsis Bundle.

 

[thegenius]

The hospital would gladly stop doing sepsis bundles if it weren't tied to CMS reimbursement. This is not the hospital's fault. Blame CMS for that.

So again, Why would a hospital want to piss off every physician to make an extra dollar?

What good is having a hospital full of employed, pissed off doctors? That hospital wouldn't last long.

 

[RustedFox]

The hospital would gladly stop doing sepsis bundles if it weren't tied to CMS reimbursement. This is not the hospital's fault. Blame CMS for that.

So again, Why would a hospital want to piss off every physician to make an extra dollar?

What good is having a hospital full of employed, pissed off doctors? That hospital wouldn't last long.

Re-read what you just said, amigo.

Sepsis bundles piss off every physician. Especially EM/CC/ID.
Sepsis bundles make extra dollars.

 

[thegenius]

Please reread what I wrote. This is not a mandate from the hospital. The hospital is forced to do this from the insurers. The hospital did not have sepsis bundles prior to the "Surviving Sepsis" campaign. C-suite is not sitting around saying "let's fuuck the doctors by forcing them to do sepsis bundles."

I know you know that it's difficult to run a business where every key employee is pissed off at the employer.

 

[RustedFox]

Please reread what I wrote. This is not a mandate from the hospital. The hospital is forced to do this from the insurers. The hospital did not have sepsis bundles prior to the "Surviving Sepsis" campaign. C-suite is not sitting around saying "let's fuuck the doctors by forcing them to do sepsis bundles."

I know you know that it's difficult to run a business where every key employee is pissed off at the employer.

Fair enough. I *did* mis-read what you wrote. I'm pretty beat.

 

[EctopicFetus]

Hospitals don’t sit around thinking how they can piss off docs. Instead they think how they can make more money without any thought or consideration for physicians or patients unless it impacts their bottom line. No hospital ever was like hey we could do this and we would make extra money but the docs won’t like it So we won’t. Let’s not be gullible. They only care about docs cause they need us to keep feeding their financial machine. Nothing more or less.

 

[thegenius]

What I believe is hospitals are run like every other business that makes billions(s) a year (our hospital gross revenue is about 1B). They do sit around and look at budgets, income, costs, etc. The try to maximize value and revenue and minimize cost and risk. They don't sit around and say "I dont give a flying fuuck about our employees". That is what's intonated several posts above.

I do think that hospitals do things, mainly institute protocols, without much thought or consideration for some of their doctors, like force us to fill out more paperwork or put in orders into the EMR that doesn't help the patient, but does help them run reports for compliance, for instance. A far cry from c-suite admin not giving one damn about the doctors.

 

[DoctwoB]

When dealing with any large administration, Hanlon’s razor applies

“never attribute to malice that which is adequately explained by stupidity"

 

[benem]

Hospitals don’t sit around thinking how they can piss off docs. Instead they think how they can make more money without any thought or consideration for physicians or patients unless it impacts their bottom line. No hospital ever was like hey we could do this and we would make extra money but the docs won’t like it So we won’t. Let’s not be gullible. They only care about docs cause they need us to keep feeding their financial machine. Nothing more or less.

I definitely think there’s a spectrum of how much they value physicians though. Unfortunately EM seems to fall at the bottom unless there are unique circumstances that would make replacement difficult or it’s in academics. People would be up in arms if their local hospital cut ties with their oncologist or cardiologist but EM/Rads/Anes are all replaceable. Admins only seem to truly listen when they screw things up and hospital operations are impacted as a whole, looking at you, Summa.

 

[EctopicFetus]

I definitely think there’s a spectrum of how much they value physicians though. Unfortunately EM seems to fall at the bottom unless there are unique circumstances that would make replacement difficult or it’s in academics. People would be up in arms if their local hospital cut ties with their oncologist or cardiologist but EM/Rads/Anes are all replaceable. Admins only seem to truly listen when they screw things up and hospital operations are impacted as a whole, looking at you, Summa.

It comes down to money. Ortho cardiology and neurosurgery make them tons of money. Hence they have a ton of clout.

The @thegenius when they don’t take you into account they don’t care about you. They care about revenue expenses and profits. No they don’t want to be outwardly antagonistic but they don’t care about docs. If it saves them 50k a year but makes the Ed docs miserable it will be instituted.