Brigade4Radiant

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The vast majority of CMG contracts are independent contractors in fact this EMGs have an actually lobby certain states like Tennessee where it’s against the law to classify us asemployees so they can staff the emergency department.
 
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maxxor

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That's interesting info. The question I have is, are these radiology residencies spots funded traditionally by Medicare or is HCA funding them wholly? Is the HCA hospital just an affiliate/partner institution that outside residents rotate through? For example, they list Tulane Medical Center in New Orleans. I'm guessing that Tulane Medical Center and its radiology residency are probably owned by Tulane University School of Medicine and not by HCA? The other listed programs are tiny, based in small community hospitals, and probably not very good. Many of them are probably DO-based programs. My group is highly unlikely to hire any graduates from such programs.

Take a closer look at the booklet that lists all of the HCA residencies and fellowships (starting at page 14). It not only includes radiology and EM but other desirable specialities like derm, ENT, orthopedic surgery, neurosurgery, vascular surgery, plastic surgery, cardiology, and GI.


Combined, all HCA hospitals have the financial resources, infrastructure, network, and volume to create whatever residencies and fellowships they want. Our respective medical societies need to make sure that the accreditation requirements are high enough to deter for-profit entities like HCA from easily creating residencies and fellowships at each tiny community hospital it owns. Make it so financially and logistically painful for HCA to open one so that they have to really want it based on real need instead of financial/market control reasons. This is how you prevent HCA from flooding and controlling the market.
HCA has bought some academic hospitals (Tulane and I think 1 in Georgia) so the medical school becomes a joint venture between the academic instruction and HCA. It’s sort of like the quasi relationship when a medical school has multiple hospitals (Harvard most notably is like this).

For those hospitals, HCA can claim they provide those residencies, because they do.

After having read through their GME website, I think the residencies at real places were the residencies in existence when a formerly academic hospital was taken over and are probably Medicare funded. However, I do think they have learned from the academic places how to grease the ACGME wheels to open new residencies in abysmal locations which are entirely HCA funded.

that Las Vegas residency is staffed by a Private Equity practice and it’s across 3 medium sized hospitals.

It’s not encouraging to be honest that they are pursuing this in Radiology, even in the early stages. I encourage you to look up the RRC case minimums for us. It’s a joke. I almost had them all by end of R1.
 
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RustedFox

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The vast majority of CMG contracts are independent contractors in fact this EMGs have an actually lobby certain states like Tennessee where it’s against the law to classify us asemployees so they can staff the emergency department.

Its against the law in TN to classify us as W2 employees?
 
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MS1 here. Well damn. Guess I will scratch EM off my list. Maybe anesthesiology too. How disappointing. At least I got some years to see how things will shake out. Do you think there is any hope for EM or is this specialty screwed?
 
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MS1 here. Well damn. Guess I will scratch EM off my list. Maybe anesthesiology too. How disappointing. At least I got some years to see how things will shake out. Do you think there is any hope for EM or is this specialty screwed?
For real, I'm a MS1 as well and EM is basically what I have envisioned myself doing my whole life. Going through forums it's tough to see a field where they aren't pessimistic about their future. Rads, Anesthesia, Nephrology, EM, Rad Onc, etc. Like Derm or bust I guess.
 
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bravotwozero

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MS1 here. Well damn. Guess I will scratch EM off my list. Maybe anesthesiology too. How disappointing. At least I got some years to see how things will shake out. Do you think there is any hope for EM or is this specialty screwed?

In the near future it certainly looks like we're toast. But like @emergentmd stated, none of us have a crystal ball to look for unforeseen events. Five years ago, this was unthinkable. Maybe other events can happen and alter the course of our profession in a more positive direction. You just don't know. Regardless, your concerns are well founded, and I think you'd do well to heed the oft given advice here to go into a specialty where you get to own your job, and remain outside the clutches of the hospital system, assuming you like that specialty and are able to enter it of course.
 
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GeneralVeers

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In fairness the HCA Vegas residency includes a Level 2 trauma center and the biggest hospital in the state with 750 beds and 100k ED visits. Unfortunately their "primary" site is a typical non trauma community ED with about 50k visits.
 
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Rekt

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Actually got around to watching the acep video. It's even worse than people think.

Also caught most of the AAEM town hall. Overall just missing the forest for the trees. The first speaker and Macnamara seem like the only people who have a clue what to do. Everyone else too busy pissing in the wind.

Time to pack it up.
 
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EctopicFetus

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Actually got around to watching the acep video. It's even worse than people think.

Also caught most of the AAEM town hall. Overall just missing the forest for the trees. The first speaker and Macnamara seem like the only people who have a clue what to do. Everyone else too busy pissing in the wind.

Time to pack it up.
And do what?
 
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Default on my loans. Claim disability due to anxiety, metastatic fibromyalgia, and gastroparesis. Get on medicaid and come to the ED every day
And here we see Rekt, who upon emerging from the chrysalis of EM, has metamorphosed into what we were all destined to be - that which we hate the most. Embrace it man.
 
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GeneralVeers

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And here we see Rekt, who upon emerging from the chrysalis of EM, has metamorphosed into what we were all destined to be - that which we hate the most. Embrace it man.

It's the natural of order for everyone these days. Can't handle life? Go on the government dole, claim disabling health problems and milk the system for all its worth.
 
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Birdstrike

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It's the natural of order for everyone these days. Can't handle life? Go on the government dole, claim disabling health problems and milk the system for all its worth.
I personally know an ER doc that got a full ride on a private disability policy due to having dry eyes. "Can't see when intubating." Seriously, it worked. Never had to work again.
 
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For real, I'm a MS1 as well and EM is basically what I have envisioned myself doing my whole life. Going through forums it's tough to see a field where they aren't pessimistic about their future. Rads, Anesthesia, Nephrology, EM, Rad Onc, etc. Like Derm or bust I guess.
Derm is infiltrated by PE/corporate too and faces midlevel encroachment.
 
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solitarius

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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.

For real, I'm a MS1 as well and EM is basically what I have envisioned myself doing my whole life. Going through forums it's tough to see a field where they aren't pessimistic about their future. Rads, Anesthesia, Nephrology, EM, Rad Onc, etc. Like Derm or bust I guess.

Yeah, there's definitely a set of hardcore EM groupies in every class. EM is one of the most accessible specialties for premeds to gain clinical experience. Some people decided to apply to medical school because of their past lives as EMTs, scribes, or research; so deciding to suddenly not to do EM opens up an uncomfortable kind of existential self-evaluation.

At least at my school, there was a cult-like devotion to EM among the aspirants. Hanging out together, going to the same conferences, submitting work to SAEM or ACEP, nerding out about how "EM is the coolest specialty". It's not like you can suddenly decide to apply to another competitive specialty in MS4 after riding the EM roller coaster through the first three years.

I also think it's hard for EM-bound students to choose another specialty because EM appears very cool and interesting when you are on the outside looking in. I learned a lot on my rotations there, and it was a fantastic learning experience even if it wasn't something I wanted to do in the long run. Med students aren't thinking about practical things like mid-levels, EMTALA, or burnout. They're 100% zoomed in on trying to become better clinicians, and EM just looks exciting initially.

So yeah, it will take awhile before these die-hard EM groupies divert elsewhere and ruin those specialties instead.
 
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wamcp

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Default on my loans. Claim disability due to anxiety, metastatic fibromyalgia, and gastroparesis. Get on medicaid and come to the ED every day
Don’t forget terminal lumbago. RDR2 anyone?
 
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Steve_Zissou

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“Physician assistants and nurse practitioners play a valuable role in the ED.”[ii] Importantly, PA practice has been extensively studied and evaluated, and PAs have been found to provide high-quality patient care similar to that of physicians.”

Uffff, I guess it’s untrue that physicians add any benefit to care in the ED. At least, according to the AAPA.
 

GoCards05

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“Physician assistants and nurse practitioners play a valuable role in the ED.”[ii] Importantly, PA practice has been extensively studied and evaluated, and PAs have been found to provide high-quality patient care similar to that of physicians.”

Uffff, I guess it’s untrue that physicians add any benefit to care in the ED. At least, according to the AAPA.
Yikes, we have created a monster.
 
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EctopicFetus

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“Physician assistants and nurse practitioners play a valuable role in the ED.”[ii] Importantly, PA practice has been extensively studied and evaluated, and PAs have been found to provide high-quality patient care similar to that of physicians.”

Uffff, I guess it’s untrue that physicians add any benefit to care in the ED. At least, according to the AAPA.
Fun experiment (I can wish). Find 2 busy high acuity EDs. Say LA county and Cook county (just to make sure you get some of the county nonsense in there).

Run them for 6 months compare outcomes. I for one have 0 concern the physician one would be incredibly cheaper, have better outcomes and have better throughput.

MLPs order idiotic tests, cant take care of the sick, and while they may give out opiates like tic tacs, z paks like hubba bubba and steroids like skittles their patient satisfaction scores would probably be higher if they didn't account for the insane amount of people who left AMA.

I like PAs. My group uses them and they are far far superior to the Jenny McJennysons they however have 0 ability to see sick patients quickly, efficiently and accurately.
 
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jw3600

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T minute 5 minutes until Dr. PA shows up and explains he’s been saying this for years!!! Thank god the AAPA has his back now.
 
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Arcan57

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The funny thing is everyone leaning on patient outcomes to save emergency physicians from independent practitioners (IPs). In states with independent practice NP/PAs, watch how malpractice reform gets instituted as soon as deep pocketed institutions are reliably on the hook. What we need to do is create our own body of literature that hiring EPs only or a certain EP/non-independent practitioner ratio is cheaper, more efficient, and leads to better outcomes than IP run departments. And we need to get that out now, before IP led is the defacto position.
 
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DocEspana

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has everyone been discussing the Envision-sponsored ACEP course powerpoint here? We should be. If you dont know about it, I could potentially post it. but the short version is ACEP has a leadership conference and a speech sponsored by an envision big-wig was given where it heaped praise on the value midlevels provide, encouraged directors to create byzantine schedules to keep physician staffing as targeted as possible to trends noting that overcrowding is often temporary, explained that nearly everything can be done by midlevels or FM at lower rates than EM trained doctors, and reminded them to be aware that physician salaries make up a (almost certainly grossly exaggerated) large chunk of ED expenses.

anyway I'm not here to talk about that. I'm here to talk about how various somewhat prominent people in AAEM are the source of the leak and the primary people amplifying it through the internet. And I'm generally pretty dismissive of AAEM as a rather impotent little organization but in this case I say ****ING GOOD JOB. Seriously. Good for them. Well now it seems that ACEP members are making twitter burner/ghost accounts, all opened just days ago, to troll these prominent AAEM members by smearing their name (and AAEMs name in general) and suggesting *they* are the ones who are in bed with corporate interests and shouldnt be trusted. Which makes no sense given AAEM's whole deal. Anyway, it would appear they messed up a bit by getting followed by various big names in ACEP, so its relatively clear that the person behind it isnt just some random ACEP fanatic but someone actually attached to the organization somewhere higher up the food chain.

This is a really REALLY disgusting case of infighting (the disgusting part being entirely from ACEPs end right now) when both groups should be looking out (as, to their credit, AAEM currently is) to the bigger issue facing us all.
 
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RustedFox

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the short version is ACEP has a leadership conference and a speech sponsored by an envision big-wig was given where it heaped praise on the value midlevels provide, encouraged directors to create byzantine schedules to keep physician staffing as targeted as possible to trends noting that overcrowding is often temporary, explained that nearly everything can be done by midlevels or FM at lower rates than EM trained doctors, and reminded them to be aware that physician salaries make up a (almost certainly grossly exaggerated) large chunk of ED expenses.

This is why ACEP needs to be sued out of existence.
 
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Rekt

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has everyone been discussing the Envision-sponsored ACEP course powerpoint here? We should be. If you dont know about it, I could potentially post it. but the short version is ACEP has a leadership conference and a speech sponsored by an envision big-wig was given where it heaped praise on the value midlevels provide, encouraged directors to create byzantine schedules to keep physician staffing as targeted as possible to trends noting that overcrowding is often temporary, explained that nearly everything can be done by midlevels or FM at lower rates than EM trained doctors, and reminded them to be aware that physician salaries make up a (almost certainly grossly exaggerated) large chunk of ED expenses.

anyway I'm not here to talk about that. I'm here to talk about how various somewhat prominent people in AAEM are the source of the leak and the primary people amplifying it through the internet. And I'm generally pretty dismissive of AAEM as a rather impotent little organization but in this case I say ****ING GOOD JOB. Seriously. Good for them. Well now it seems that ACEP members are making twitter burner/ghost accounts, all opened just days ago, to troll these prominent AAEM members by smearing their name (and AAEMs name in general) and suggesting *they* are the ones who are in bed with corporate interests and shouldnt be trusted. Which makes no sense given AAEM's whole deal. Anyway, it would appear they messed up a bit by getting followed by various big names in ACEP, so its relatively clear that the person behind it isnt just some random ACEP fanatic but someone actually attached to the organization somewhere higher up the food chain.

This is a really REALLY disgusting case of infighting (the disgusting part being entirely from ACEPs end right now) when both groups should be looking out (as, to their credit, AAEM currently is) to the bigger issue facing us all.
Not really sure how you could not like AAEM. They've essentially been on the ball for years actually fighting in our best interest. They don't have the funding to make big moves, but hopefully that changes. ACEP has been ajoke for years and sucking on the CMGs hard.
 
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DocEspana

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Not really sure how you could not like AAEM. They've essentially been on the ball for years actually fighting in our best interest. They don't have the funding to make big moves, but hopefully that changes. ACEP has been ajoke for years and sucking on the CMGs hard.

If you're asking why I *specifically* was not always the best fan of AAEM, it has to do with my involvement with the AMA and AAEM taking only the most minimal of steps to get involved with the AMA in a (if I'm allowed to editorialize) peripheral manner that they clearly did on the principle of not wanting to take part. Except that just makes me think their leadership (back then) was stupid to squander all the influence the AMA could give them and then complain that they're too resource strapped to have influence - even though the AMA is doling it out in heaping portions to anyone, including ACEP, who wants it.

It's a *highly specific* criticism about them wanting to complain about not being powerful enough to be held responsible for not succeeding while squandering chances to become more influential. It's a very technical complaint and has little to do with their policies. It is also, from what I can tell, something they are no longer doing (as much) - and I do agree that it's hard to dislike what they stand for.
 
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vm26

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Yikes, we have created a monster.

“Physician assistants and nurse practitioners play a valuable role in the ED.”[ii] Importantly, PA practice has been extensively studied and evaluated, and PAs have been found to provide high-quality patient care similar to that of physicians.”

Uffff, I guess it’s untrue that physicians add any benefit to care in the ED. At least, according to the AAPA.

I dd not see a response to the issue of job saturation?

Unless I am misinterpreting, seems like we just had an increase in training spots this past year


 
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