EM Future

[cyanide12345678]

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Great question.

In the days when there were literally no docs to work in rural EDs, I could understand the rationale of allowing for somewhat laxed program accrediting guidelines. Times have certainly changed though. Given that the projected surplus of EM-trained docs by the end of this decade will be more than 2x higher than the number of neurosurgeons in the US (yes, the # of jobless EM docs alone will be >2x higher than all the brain surgeons we have), it absolutely makes sense from the patient-safety perspective to adjust the requirements to make sure we only produce extremely well-trained EM docs going forward.

Here's a list of the ACGME's current EM RRC members:

Emergency Medicine

Maybe a good starting point, and potentially low hanging fruit, would be for people to take a look and see if they know any of these folks well enough to grab a coffee/beer with them. You could ask their rationale for how they determine the residency accreditation criteria, what they think of the current EM workforce situation, and if they think it makes sense to set the bar higher for new/continuing program accreditation since many EM residents in the near-future will be more likely to obtain unemployment benefits following graduation rather than a full time EM job.

I opened your link and realized my residency Junior is a member 😂 maybe i should send her a fb msg and be like "what the hell?!!!?"

 

[Rekt]

I’ve worked with one of the members before and have had conversations about this. According to them, it was not in their power to change the requirements. Who am I to say they were lying? I’m not sure who would have the power if not them, though. Fwiw I regard this person fairly highly. However, they did grow easily frustrated with the thought they were contributing to oversupply and tried to dismiss my concerns without much substance.

With that being said, they are an academician still trying to climb the promotion ladder. I recognize at least a couple other names on the list in this position as well. I doubt even if they had the power to go against the grain and enact meaningful change that they would, given how it could negatively impact career trajectory. People at the highest levels of power in the ivory tower institutions usually don’t have much tolerance for those who ruffle some feathers.

Maybe you should ask them now that if it's worth it to soon have ten thousand unemployed EM physicians, with likely six figure debt, some with families too, so they be can promoted? What number is acceptable for the RRC? 15,000? 20,000? When does it start to look bad on their resume that they do have some personal accountability for potentially thousands of these grads?

 

[namethatsmell]

I’ve worked with one of the members before and have had conversations about this. According to them, it was not in their power to change the requirements. Who am I to say they were lying? I’m not sure who would have the power if not them, though. Fwiw I regard this person fairly highly. However, they did grow easily frustrated with the thought they were contributing to oversupply and tried to dismiss my concerns without much substance.

With that being said, they are an academician still trying to climb the promotion ladder. I recognize at least a couple other names on the list in this position as well. I doubt even if they had the power to go against the grain and enact meaningful change that they would, given how it could negatively impact career trajectory. People at the highest levels of power in the ivory tower institutions usually don’t have much tolerance for those who ruffle some feathers.

While I don't know any of them well, I've brushed elbows with a few as well and heard lines similar to you that they "don't have the power" to change requirements.

But what's interesting is that when you look up the purpose of the Review Committees on the ACGME website, the literal first responsibility listed is "sets accreditation standards."

Committees and Members Selection Process

www.acgme.org

So when I hear from a member of the EM RC that they're powerless to do anything, I get the sense that semantics are being used for deflection...while it's probably true that an individual member of the Committee probably can't unilaterally create/change accrediting guidelines, according the ACGME the Emergency Medicine Review Committee exists to expressly do exactly that.

It kind of reminds me of that scene in Coming to America where the Queen asks the King (James Earl Jones) to allow their son to marry a commoner. The King says it's not possible because "It is against the tradition. Who am I to change it?" The Queen, deadpanned, replies "I though you were the King."

 

[jw3600]

No, APP as in American Physician Partners..., unless that was a double entendre joke of some sort...

My bad. Is that a CMG? Didn’t know that name.

 

[RustedFox]

My bad. Is that a CMG? Didn’t know that name.

A pretty evil one at that. Probably third place on the evil scale behind USACS and Envision.

 

[emergentmd]

It seems like this situation has been brewing for years. Once the Texas market imploded, I knew this was inevitable. Why are students still picking EM, a dead field? And what are PDs doing with unemployed grads?

I don't believe med student education will change a thing. Even if half the spots go unfilled, there will be many Foriegn Grads who would kill to do an EM residency.

 

[miacomet]

Meanwhile, x-ray techs in California make 130k a year plus overtime.

 

[emergentmd]

Meanwhile, x-ray techs in California make 130k a year plus overtime.

Our Rad tech makes close to 50/hr and they are almost impossible to find.

If I were not a high achiever, I would go become a rad tech. Don't deal with patient's complaints, low liability, and the current job market is endless.

Why anyone would pick something like Pharmacy making less and much more schooling dealing with difficult patients are beyond me.

 

[Taurus]

I don’t think there will be anything close to 10k unemployed EM physicians. Nor do I think there will ever be significant unemployed anesthesiologists, family docs, or internists. You know why?

Because given the choice between a midlevel and physician for the same job and salary, who do you think employers will preferentially hire? Of course, the physician! So as long as you’re willing to work for the same salary as a midlevel, you will always have a job. When the alternatives are having no job at all or working as a barista at Starbucks, most people will suck up their pride and take that job. After all, you got student loans coming due and a new family, house, and car to support!

 

[Siggy]

or only allowing EM-ICC faculty precept in the ICU,

How many critical care services are going to hire additional attendings just for a hospital to keep an EM residency?

On one hand, this may seem like more of a bug than a feature, but I seriously doubt that even the main stream EM programs are going to be able to dictate staffing of the ICU to the intensivists.

 

[wamcp]

I don’t think there will be anything close to 10k unemployed EM physicians. Nor do I think there will ever be significant unemployed anesthesiologists, family docs, or internists. You know why?

Because given the choice between a midlevel and physician for the same job and salary, who do you think employers will preferentially hire? Of course, the physician! So as long as you’re willing to work for the same salary as a midlevel, you will always have a job. When the alternatives are having no job at all or working as a barista at Starbucks, most people will suck up their pride and take that job. After all, you got student loans coming due and a new family, house, and car to support!

Yea but, greed tho

The suits don’t care. They will still hire the noctors at 50k over a doctor at 100k salary.

and don’t kid yourself that ER docs won’t be willing to accept pay below 100k:

Did you know attending nephrologists or infectious disease at “powerhouse” academic institutions are often paid 90k or less? Just too much oversupply and desirable city saturation yet they have no shortage of warm physician bodies lining up to fill their roles

 

[sylvanthus]

Ever read the med student forums and see them post that theyd do this job for very little pay cuz “its my passion” “its the only thing I can see myself doing” etc etc. Some poor bastiche will be willing to work EM for 100k a year guaranteed.

 

[partypantss]

CCM is a tight market right now, although nothing like EM. Do you think your program could set up a combined EM-IM residency for you?

I mean, I have no idea if a/ my program could do something like that. I appreciate the thinking outside the box! I honestly really wish I did EM/IM since that combo honestly would probably have been a better fit for my strengths and personality anyway, but everyone said it was a waste when I was considering it. And the way I see it I'll take a tight market over a disastrous one. CCM at least has an extra step for entry. I don't see CCM physicians flooding the market like in EM.

 

[namethatsmell]

I mean, I have no idea if a/ my program could do something like that. I appreciate the thinking outside the box! I honestly really wish I did EM/IM since that combo honestly would probably have been a better fit for my strengths and personality anyway, but everyone said it was a waste when I was considering it. And the way I see it I'll take a tight market over a disastrous one. CCM at least has an extra step for entry. I don't see CCM physicians flooding the market like in EM.

Poke around the forums more. A significant contributor to the tightening CCM market is the large amounts of midlevels being hired instead of physicians (like the EM market).

 

[hebel]

I don’t think there will be anything close to 10k unemployed EM physicians. Nor do I think there will ever be significant unemployed anesthesiologists, family docs, or internists. You know why?

Because given the choice between a midlevel and physician for the same job and salary, who do you think employers will preferentially hire? Of course, the physician! So as long as you’re willing to work for the same salary as a midlevel, you will always have a job. When the alternatives are having no job at all or working as a barista at Starbucks, most people will suck up their pride and take that job. After all, you got student loans coming due and a new family, house, and car to support!

Yay?

 

[gamerEMdoc]

How likely will SLOEs be dropped after this news? @gamerEMdoc

Haha... never.

 

[EctopicFetus]

Yay?

This is called being underemployed and it is coming. The 10k was the oversupply. Plumetting wages will lead some older docs who are nearing retirement to retire. So from that perspective, it wont be 10k. What will most likely happen is you will have a ton of docs getting done to them what they were doing to the CMGs for a while. Remember the stories of CMGs paying huge bonuses to work. This will work just the opposite. A dutch auction style. 20-30k or more of docs will become underemployed. NOt enough hours at a low rate.

 

[Lawpy]

Haha... never.

Oof.

 

[Lawpy]

Guess IM is the way to go for critical care. At least IM doesn't have this SLOE and away requirements unlike EM. Not worth this.

 

[Tipsy McStagger]

Guess IM is the way to go for critical care. At least IM doesn't have this SLOE and away requirements unlike EM. Not worth this.

I'm not sure where you are in your training, but I'm finishing up an IM-based CCM fellowship. I'm grateful for my EM training and like the way I approach patients, but if I had it to do over again I'd probably choose IM. If for no other reason you can also do pulmonary. This leaves you an out if you want, and also makes it easier to get a job since some groups are still run by PCCM. Now those jobs sometimes come with caveats (for example: on your off weeks you must see pulm consults or run clinic), but not always. CCM is also getting more popular and competitive, which means getting in from EM is potentially going to be increasingly difficult.

The other upside of IM is that if you decide you don't like acute care, you have a host of other options/fellowships. So my advice to anyone pursuing critical care is to do IM (this is 'in a nutshell' advice. We could debate the merits of Surg/Anes/EM/IM/Neuro CCM forever). Others may have differing opinions on that and that's fine too.

 

[Dr Mantis Toboggan]

This is called being underemployed and it is coming. The 10k was the oversupply. Plumetting wages will lead some older docs who are nearing retirement to retire. So from that perspective, it wont be 10k. What will most likely happen is you will have a ton of docs getting done to them what they were doing to the CMGs for a while. Remember the stories of CMGs paying huge bonuses to work. This will work just the opposite. A dutch auction style. 20-30k or more of docs will become underemployed. NOt enough hours at a low rate.

I think someone here suggested starting an MD to RN program. Could be big.

 

[Lawpy]

I'm not sure where you are in your training, but I'm finishing up an IM-based CCM fellowship. I'm grateful for my EM training and like the way I approach patients, but if I had it to do over again I'd probably choose IM. If for no other reason you can also do pulmonary. This leaves you an out if you want, and also makes it easier to get a job since some groups are still run by PCCM. Now those jobs sometimes come with caveats (for example: on your off weeks you must see pulm consults or run clinic), but not always. CCM is also getting more popular and competitive, which means getting in from EM is potentially going to be increasingly difficult.

The other upside of IM is that if you decide you don't like acute care, you have a host of other options/fellowships. So my advice to anyone pursuing critical care is to do IM (this is 'in a nutshell' advice. We could debate the merits of Surg/Anes/EM/IM/Neuro CCM forever). Others may have differing opinions on that and that's fine too.

I'm a lowly student hence a lot of questions and SLOE stuff. Really appreciate your insights!

 

[partypantss]

I'm not sure where you are in your training, but I'm finishing up an IM-based CCM fellowship. I'm grateful for my EM training and like the way I approach patients, but if I had it to do over again I'd probably choose IM. If for no other reason you can also do pulmonary. This leaves you an out if you want, and also makes it easier to get a job since some groups are still run by PCCM. Now those jobs sometimes come with caveats (for example: on your off weeks you must see pulm consults or run clinic), but not always. CCM is also getting more popular and competitive, which means getting in from EM is potentially going to be increasingly difficult.

The other upside of IM is that if you decide you don't like acute care, you have a host of other options/fellowships. So my advice to anyone pursuing critical care is to do IM (this is 'in a nutshell' advice. We could debate the merits of Surg/Anes/EM/IM/Neuro CCM forever). Others may have differing opinions on that and that's fine too.

I guess what I'm sorta confused about is what is it about IM CCM that is more desirable compared to anesthesia/ surgery CCM? Is it just that working in the MICU is preferred by people over working in the SICU? If I want to do CCM as a PGY1 EM am I really better off jumping ship completely into IM rather than just pursuing my CCM options from EM? Plus Idk how competitive one will be if they jump into whatever crappy IM residency will take a person leaving EM?

 

[Tipsy McStagger]

I guess what I'm sorta confused about is what is it about IM CCM that is more desirable compared to anesthesia/ surgery CCM? Is it just that working in the MICU is preferred by people over working in the SICU? If I want to do CCM as a PGY1 EM am I really better off jumping ship completely into IM rather than just pursuing my CCM options from EM? Plus Idk how competitive one will be if they jump into whatever crappy IM residency will take a person leaving EM?

Part of what's confusing is that there is variation among hospitals and staffing, so there no universal truth here. In general though, if you want to work in the MICU, you're best off doing a fellowship based on MICU. SICU/CVICU have their challenges, but to be honest MICU is different. You're part of a team in the SICU/CVICU and more or less you're going to be secondary to the surgical teams. MICU you're on your own, you own the patients entirely, and they can be quite medically complicated.

If you're already in EM I would not recommend jumping ship. Stick it out and apply for critical care if that's what you want to do. MICU is harder to get into, there are always unmatched anesthesia & surgical spots. It's not impossible to work in a MICU after doing SICU/anesthesia critical care, but it's an uphill battle. Those are 1 year fellowships that are often devoid of MICU time, whereas an IM-CCM program is 2 years and heavy on MICU time.

I think you should decide what type of ICU you really want to work in. If it's MICU, do what you can to get into an IM fellowship. If it's the SICU/NICU/CVICU then do either surgical/anesthesia or neuro.

 

[gamerEMdoc]

Oof.

The SLOE is just a LOR from an audition rotation. Its just standardized. Every other field expects you to audition as well. Oversupply in the market has nothing to do with rotation or application requirements. If anything, why would you make it easier to apply to EM if you are concerned about oversupply?

 

[partypantss]

Part of what's confusing is that there is variation among hospitals and staffing, so there no universal truth here. In general though, if you want to work in the MICU, you're best off doing a fellowship based on MICU. SICU/CVICU have their challenges, but to be honest MICU is different. You're part of a team in the SICU/CVICU and more or less you're going to be secondary to the surgical teams. MICU you're on your own, you own the patients entirely, and they can be quite medically complicated.

If you're already in EM I would not recommend jumping ship. Stick it out and apply for critical care if that's what you want to do. MICU is harder to get into, there are always unmatched anesthesia & surgical spots. It's not impossible to work in a MICU after doing SICU/anesthesia critical care, but it's an uphill battle. Those are 1 year fellowships that are often devoid of MICU time, whereas an IM-CCM program is 2 years and heavy on MICU time.

I think you should decide what type of ICU you really want to work in. If it's MICU, do what you can to get into an IM fellowship. If it's the SICU/NICU/CVICU then do either surgical/anesthesia or neuro.

Thanks for taking the time to go through this. With my only current guidance coming from the internet, this insight is invaluable!

 

[Lawpy]

The SLOE is just a LOR from an audition rotation. Its just standardized. Every other field expects you to audition as well. Oversupply in the market has nothing to do with rotation or application requirements. If anything, why would you make it easier to apply to EM if you are concerned about oversupply?

EM requires aways though? Unless only a home EM SLOE is allowed (the rules and policy changes have confused me, because i thought at least 2 SLOEs were required). IM and several other fields don't have this away obligation.

I'm theorizing that with the news of EM oversupply now out, the amount of residency apps will crash and programs may end up getting rid of SLOE. I'm looking at this from the MS4 demand perspective. If EM programs are increasingly going unfilled, this would end up being a problem

I'm also trying to understand why an MS4 would bother gambling their chances on aways and SLOEs that can backfire on them, especially for a field where they'll probably end up unemployed

 

[Lawpy]

I mean i understand the existence of SLOEs makes it harder to apply EM which is the point to get the number of graduating EM residents down by at least 1000. So i can see EM requirements being a lot stricter to reduce demand but that risks a lot of programs going unfilled.

 

[sylvanthus]

EM requires aways though? Unless only a home EM SLOE is allowed (the rules and policy changes have confused me, because i thought at least 2 SLOEs were required). IM and several other fields don't have this away obligation.

I'm theorizing that with the news of EM oversupply now out, the amount of residency apps will crash and programs may end up getting rid of SLOE. I'm looking at this from the MS4 demand perspective. If EM programs are increasingly going unfilled, this would end up being a problem

I'm also trying to understand why an MS4 would bother gambling their chances on aways and SLOEs that can backfire on them, especially for a field where they'll probably end up unemployed

They wont go unfilled, if anything IMGs/FMGs will take the spot. There is no incentive to make things easier to get into EM.

 

[sylvanthus]

Med students in general
are also naive. I was the same way. Even if someone told me EM was collapsing, I still woulda followed my path. I mean were all unique and special and “ill find a job!” “I wont be that guy” etc etc. Too many med students when I bring up the issues say the same things “ cant see myself doing anything else” “ id do EM for 100/hr” etc etc etc.

EM will still fill for years to come.

 

[partypantss]

I mean i understand the existence of SLOEs makes it harder to apply EM which is the point to get the number of graduating EM residents down by at least 1000. So i can see EM requirements being a lot stricter to reduce demand but that risks a lot of programs going unfilled.

Dude what are you even talking about? SLOES are not a new thing and are meant to evaluate candidates not reduce the number of applicants lol EM has had no problem filling their spots.

 

[EctopicFetus]

I think someone here suggested starting an MD to RN program. Could be big.

Nothing else might show the world how completely ridiculous the current system is. They want to upend it this is the way. we have allowed the system to become so ass backwards we have these types of discussions and it actually be a legit solution.

 

[EctopicFetus]

Med students in general
are also naive. I was the same way. Even if someone told me EM was collapsing, I still woulda followed my path. I mean were all unique and special and “ill find a job!” “I wont be that guy” etc etc. Too many med students when I bring up the issues say the same things “ cant see myself doing anything else” “ id do EM for 100/hr” etc etc etc.

EM will still fill for years to come.

Hence why our rates will plummet.

 

[Lawpy]

They wont go unfilled, if anything IMGs/FMGs will take the spot. There is no incentive to make things easier to get into EM.

Huh, ok i was mistaken on that.

Dude what are you even talking about? SLOES are not a new thing and are meant to evaluate candidates not reduce the number of applicants lol EM has had no problem filling their spots.

I know, but because SLOEs are currently an EM only thing, i was trying to find what MS4s would go through the hassle of aways and SLOEs and was thinking EM would go unfilled due to collapsed demand. That was wrong apparently.

 

[sylvanthus]

Med students would eat a poop hotdog to get into EM even with the job
market tanking.

 

[gamerEMdoc]

EM requires aways though? Unless only a home EM SLOE is allowed (the rules and policy changes have confused me, because i thought at least 2 SLOEs were required). IM and several other fields don't have this away obligation.

I'm theorizing that with the news of EM oversupply now out, the amount of residency apps will crash and programs may end up getting rid of SLOE. I'm looking at this from the MS4 demand perspective. If EM programs are increasingly going unfilled, this would end up being a problem

I'm also trying to understand why an MS4 would bother gambling their chances on aways and SLOEs that can backfire on them, especially for a field where they'll probably end up unemployed

1000 more people applied for EM spots last year than matched EM. They won’t go unfilled. They’ll at worst get taken up by IMGs. EM not being as popular with students isn’t going to stop the oversupply because there will still be people to take the spots even if there was a decent reduction in applicants.

 

[gamerEMdoc]

Huh, ok i was mistaken on that.


I know, but because SLOEs are currently an EM only thing, i was trying to find what MS4s would go through the hassle of aways and SLOEs and was thinking EM would go unfilled due to collapsed demand. That was wrong apparently.

Getting a SLOE isn’t a hassle. Its asking for a LOR. You aren’t going to apply to any field without doing at least 1 rotation in said field and getting a LOR from it. There is literally nothing else that you have to do to get a SLOE compared to getting a LOR. Same ERAS request. No one requires an away either. 90% of programs have said in past surveys they are ok with one SLOE. And in the COVID era, its encouraged that programs be ok with only one SLOE since some students can’t get away rotations.

 

[Lawpy]

Med students would eat a poop hotdog to get into EM even with the job
market tanking.

1000 more people applied for EM spots last year than matched EM. They won’t go unfilled. They’ll at worst get taken up by IMGs. EM not being as popular with students isn’t going to stop the oversupply because there will still be people to take the spots even if there was a decent reduction in applicants.

Hm i was wrong about MS4 EM demand dropping. I was thinking it'd follow the radonc recent decline but looks unlikely.

I need to revisit the posted slides and earlier discussions but how likely is forcing EM programs to take in fewer interns? And thus make EM artificially more competitive and selective to sort out the saturation issues. Closing EM programs looks unlikely

 

[2021Doctor]

I think there will be many EM spots in the SOAP next year. Do you really think programs will not fill their slots just because an applicant in the SOAP does not have a SLOE?

 

[miacomet]

1000 more people applied for EM spots last year than matched EM. They won’t go unfilled. They’ll at worst get taken up by IMGs. EM not being as popular with students isn’t going to stop the oversupply because there will still be people to take the spots even if there was a decent reduction in applicants.

You are usually an optimist...thoughts now?

 

[ace_inhibitor111]

There really aren’t many good options for the average med student to apply to anymore. Everything except IM, FM and pediatrics had <90% match rate for USMD seniors this year. I expect an uptick in IM applicants next year based on the new ACEP findings. Still, there are plenty of students who don’t know or don’t care and will apply EM.

 

[wamcp]

Med students in general
are also naive. I was the same way. Even if someone told me EM was collapsing, I still woulda followed my path. I mean were all unique and special and “ill find a job!” “I wont be that guy” etc etc. Too many med students when I bring up the issues say the same things “ cant see myself doing anything else” “ id do EM for 100/hr” etc etc etc.

EM will still fill for years to come.

Yes. Just browsed through one of the med student threads. The ridiculousness.

I mean, 60 hour work weeks isn’t bad. 50-60 is pretty average for most specialties....

As someone who has worked an average of 75-80 hours a week for years with a family, it is totally possible to do both. Working 60 hours a week leaves 50 hours a week with my family, not including the time spent sleeping....

Also even working 80 hours a week on my gen surg rotation, I still got 7 hours of sleep.

 

[DocEspana]

Rosenberg is a quack who employs holistic nurses to perform energy healing on emergency patients.

I broke my leg, doc, so why is that lady playing the harp? — Jennifer Margulis

Dr. Mark Rosenberg believes holistic practices and a more human touch—both literally and figuratively—can improve Emergency Room care and patient outcomes.

www.jennifermargulis.net

Heh. I interviewed at his hospital. I forget if he was program director for the residency or director of the ED (I'm too lazy to look it up) but whichever one he was, the *other* one was throwing some shade at him during the interview for his obsession with color therapy and music therapy and all that holistic stuff as the best way to cure maladies in a population that is largely drug overdoses, gang violence, and (because they're chubby in Paterson) cholelithiasis.

Thats my lasting memory of him.

 

[Fox800]

Yes. Just browsed through one of the med student threads. The ridiculousness.

Sheep...sigh.

 

[Steve_Zissou]

Med students in general
are also naive. I was the same way. Even if someone told me EM was collapsing, I still woulda followed my path. I mean were all unique and special and “ill find a job!” “I wont be that guy” etc etc. Too many med students when I bring up the issues say the same things “ cant see myself doing anything else” “ id do EM for 100/hr” etc etc etc.

EM will still fill for years to come.

This is exactly what I’m seeing in close friends who are pursuing EM for the match next year. I abandoned EM and anesthesia both as options. The writing is on the wall and I don’t want to be the one taking on that uphill battle.

Remind me again, why the hell do we have midlevels at all when other countries get by just fine without them?

 

[dadaddadaBATMAN]

Yes. Just browsed through one of the med student threads. The ridiculousness.

Since doing 80 hrs a week is just as sustainable for 8 weeks as it is for 30 years right....

And 60 hrs with a rotating circadian clock? I don’t think you could pay me enough money (ok you could, but I’d have to be able to retire after the two years it took me to burn to a crisp)

I know a few folks from a generation back that pulled those hours in em, but it was a different beast at the time, and you often slept at least from 12a-4a at a reasonably busy place. The job was also very different in general, and there was a lot less dumping of sub specialist care on the ed. And of the docs from that generation that I know, literally 1/30 or so is still in practice at the 30 year mark. Even the old guard couldn’t keep that up long, most of them burned out in 5-10 years

 

[VA Hopeful Dr]

This is exactly what I’m seeing in close friends who are pursuing EM for the match next year. I abandoned EM and anesthesia both as options. The writing is on the wall and I don’t want to be the one taking on that uphill battle.

Remind me again, why the hell do we have midlevels at all when other countries get by just fine without them?

Other countries: ration care, don't go to the doctor with every jammed finger and sore throat that they woke up with literally that day, don't have our malpractice environment/EMTALA/satisfaction scores so doctors there can say "there's nothing wrong with you, go home".

I'm sure there's more but those are the big ones.

 

[CargoPants]

Lol. 😂 That’s what I keep telling you guys. It’s not that simple to open a radiology residency. You need enough volume and subspecialty expertise for the residents to rotate through, ie, chest, body, neuro, MSK, peds, mammo, IR, nucs, etc. An HCA hospital staffed by 3 radiologists isn’t going to cut it. We have multiple HCA hospitals in my desirable large city and I have radiology privileges at all of them. Even at the largest HCA hospital in town, it’s only staffed by 3 radiologists on-site. We of course have other subspecialty radiologists off-site who read HCA hospital studies as well. Even if all the radiologists were on-site, you probably only need 10 of them to staff daily. Not enough for a residency.

Even the smallest radiology residencies have at least 15-20 radiologists on-site. Could you have the residents rotate at multiple HCA hospitals in multiple cities or states? Yes, but that would be a financial and logistical nightmare for both the program and residents. Even if HCA did this and opened a few radiology residencies, it won’t create a significant increase in the number of radiology graduates to impact the job market. Like I keep saying, the biggest threat to radiology is corporate radiology and Wall Street.

Do these not qualify?

Graduate Medical Education Programs at HCA Healthcare

HCA offers innovative, high-quality graduate medical education programs.

hcahealthcare.com

Looks like the smallest program (Trinity) has 10 radiology faculty. I'm not sure when they opened, but it looks like they have 4 residents, so it must have been within the last 2 years.

Edit:
Additionally, if you include "Diagnostic Radiology" with "Radiology" it includes MountainView Hospital in Nevada. It looks like both Trinity and MountainView both have opened in the last 2 years.

 

[Steve_Zissou]

Other countries: ration care, don't go to the doctor with every jammed finger and sore throat that they woke up with literally that day, don't have our malpractice environment/EMTALA/satisfaction scores so doctors there can say "there's nothing wrong with you, go home".

I'm sure there's more but those are the big ones.

Those are good points. TBH, I don’t have an intimate enough knowledge of other healthcare systems to comment much on this. My question is, is the need for midlevels actually so great in the US?

 

[bravotwozero]

Those are good points. TBH, I don’t have an intimate enough knowledge of other healthcare systems to comment much on this. My question is, is the need for midlevels actually so great in the US?

Need for midlevels, no. Desire for lots of profit by cutting costs, you betcha. That's why we have them.