EM Future

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miacomet said:
That's an insane number of spots. Do we really need that many EM docs?
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Of course not. We're about 840 overproduced. 2k spots flat is a fine number.
gutonc said:
Yeah...you guys are f’d. That’s insane.
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Is it possible to create an EM to FM fellowship? 100% serious.
 
blue.jay said:
Match data is released. 2840 EM positions offered, 2826 filled in the match. Only 14 unfilled spots.
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In terms of the other generalist type fields, we are now on par with pediatrics. Surpassed psych (just under 2k), anesthesiology (just under 1500), and OBGYN (just under 1500) by a significant margin. We’ll be approaching FM soon enough (just under 5k). EM is actively being commoditized.
 
dadaddadaBATMAN said:
Emergent, I have no specific problem with you, but I have been on this forum a long, long time, and wasted far too much time here.

I remember another doctor who was “whining” nonstop in the late 2000s despite making twice what we make and wanting to switch to radiology. It was you (I quoted the thread above).

So try to tap into that memory and have a little empathy for people who are feeling similar angst to what you did. Hopefully they find the same peace with the field that you eventually came to.
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tenor (1).gif
 
GatorCHOMPions said:
In terms of the other generalist type fields, we are now on par with pediatrics. Surpassed psych (just under 2k), anesthesiology (just under 1500), and OBGYN (just under 1500) by a significant margin. We’ll be approaching FM soon enough (just under 5k). EM is actively being commoditized.
Click to expand...

Someone do some fast math and count how many of those spots are HCA.
 
If HCA is opening up EM programs, what is to stop them from starting a urology, plastics, FM, derm, or ortho program? Or fellowships?
 
bravotwozero said:
If HCA is opening up EM programs, what is to stop them from starting a urology, plastics, FM, derm, or ortho program? Or fellowships?
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They could, but all these fields can own their own practices and chose to divorce themselves from HCA...or any hospital for that matter. Well I guess urology is somewhat more dependent on hospitals than the others, but not fully...and uro's are also wise and militant about not creating a surplus of themselves.
 
If HCA is opening up EM programs, what is to stop them from starting a urology, plastics, FM, derm, or ortho program? Or fellowships?
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HCA community hospitals tend to have relatively unimpressive volume for something like urology compared to big giant academic centers . For example, you average community hospital has what like 2 or 3 urology docs on panel? It will be a lot harder to get all the case requirements, faculty, etc lined up than EM.

Additionally, a lot of HCA ED's do decent enough volume to warrant still 10+ EM docs and a number of NP/PA's on staff... enter the benefit of resident labor in the ED.

I dont think many if any HCA hospitals are comparatively so swamped with uro cases that they need resident labor.

Also perhaps those specialty boards screw down the hatch tighter than ACEP has... I don't know.

They already have been hitting FM and fellowships.
 
Rekt said:
Of course not. We're about 840 overproduced. 2k spots flat is a fine number.


Is it possible to create an EM to FM fellowship? 100% serious.
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I think you'd get a solid year credit, so an FM residency could be done in 2 years
 
bravotwozero said:
If HCA is opening up EM programs, what is to stop them from starting a urology, plastics, FM, derm, or ortho program? Or fellowships?
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They are opening lots of FM residencies
 
bravotwozero said:
If HCA is opening up EM programs, what is to stop them from starting a urology, plastics, FM, derm, or ortho program? Or fellowships?
Click to expand...

My guess is the bar to open a residency program is higher in those other specialties.
 
Frazier said:
HCA community hospitals tend to have relatively unimpressive volume for something like urology compared to big giant academic centers . For example, you average community hospital has what like 2 or 3 urology docs on panel? It will be a lot harder to get all the case requirements, faculty, etc lined up than EM.

Additionally, a lot of HCA ED's do decent enough volume to warrant still 10+ EM docs and a number of NP/PA's on staff... enter the benefit of resident labor in the ED.

I dont think many if any HCA hospitals are comparatively so swamped with uro cases that they need resident labor.

Also perhaps those specialty boards screw down the hatch tighter than ACEP has... I don't know.

They already have been hitting FM and fellowships.
Click to expand...
 
Frazier said:
HCA community hospitals tend to have relatively unimpressive volume for something like urology compared to big giant academic centers . For example, you average community hospital has what like 2 or 3 urology docs on panel? It will be a lot harder to get all the case requirements, faculty, etc lined up than EM.

Additionally, a lot of HCA ED's do decent enough volume to warrant still 10+ EM docs and a number of NP/PA's on staff... enter the benefit of resident labor in the ED.

I dont think many if any HCA hospitals are comparatively so swamped with uro cases that they need resident labor.

Also perhaps those specialty boards screw down the hatch tighter than ACEP has... I don't know.

They already have been hitting FM and fellowships.
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They have one urology residency (technically) and that is Tulane.

hcahealthcare.com

Graduate Medical Education Programs at HCA Healthcare

HCA offers innovative, high-quality graduate medical education programs.
hcahealthcare.com hcahealthcare.com
 
GatorCHOMPions said:
My guess is the bar to open a residency program is higher in those other specialties.
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Surgeons have balls and stand up for themselves and their specialties. They go alpha-ballistic when threatened and defend turf like pitbulls looking to maim and haven't allowed it to happen. When's the last time you saw an EM representative society go nuclear, not with mere 'strong words' or a position paper, but truly action-aggressive in defending pit docs' interests?
 
Birdstrike said:
Surgeons have balls and stand up for themselves and their specialties. They go alpha-ballistic when threatened and defend turf like pitbulls looking to maim and haven't allowed it to happen. When's the last time you saw an EM representative society go nuclear, not with mere 'strong words' or a position paper, but truly action-aggressive in defending pit docs' interests?
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Oh man, so much truth in here it hurts. Anyone else remember what the general surgeons did in West Virginia? They had it with the BS lawsuits in the state, so they actually went on STRIKE until they got tort reform! Imagine that!
 
Nationally, we could strike. It would take unprecedented coordination and even 5% of people breaking the strike would probably ruin it

But one day in America without docs in the ED wouldn't go unnoticed and legislation would soon follow
 
GatorCHOMPions said:
In terms of the other generalist type fields, we are now on par with pediatrics. Surpassed psych (just under 2k), anesthesiology (just under 1500), and OBGYN (just under 1500) by a significant margin. We’ll be approaching FM soon enough (just under 5k). EM is actively being commoditized.
Click to expand...

Does that include DO numbers for the other specialties the way it does for EM now?
 
I'm so embarrassed I went into this field. I feel like I was manipulated by academic EM docs who wanted to burnish their own resumes by sending people into the field. I'm surprised reputable schools aren't advising against EM. I could have matched in a bunch of better fields- decent IM, gen surg at a decent place. Maybe subspecialty. And I threw it all away.

HCA has a bunch of FM, IM, and I think a few GS residencies.

EM is done. There is no decent exit plan within medicine; what is everyone planning on doing?
 
miacomet said:
I'm so embarrassed I went into this field. I feel like I was manipulated by academic EM docs who wanted to burnish their own resumes by sending people into the field. I'm surprised reputable schools aren't advising against EM. I could have matched in a bunch of better fields- decent IM, gen surg at a decent place. Maybe subspecialty. And I threw it all away.

HCA has a bunch of FM, IM, and I think a few GS residencies.

EM is done. There is no decent exit plan within medicine; what is everyone planning on doing?
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Considering a fellowship, working internationally, or taking a government position (DOD, VA, etc).
 
EM exit strategies I know of so far

Without fellowship:
Telemedicine
Urgent Care
Wound Care
Start your own business with the above.

With fellowship:
Critical Care
Sports med
Pain med
And admin? Maybe?

anything I forgot? The options seem limited compared to other specialties
 
clibby said:
The problem is that we have shown you don't need IM or FM training to be a good ED doc and ED training alone isn't enough to to IM or FM. What benefit would there be to a 3 year EM fellowship vs a 3 year EM residency? They already have EM/IM and EM/FM combined residencies and they are 5 years. I guess I'm not sure the problem that is being solved by your proposed change.

If anything, EM is likely to become a bigger feeder into CCM and more desired in the urgent care market. EM docs can also do a 1-2 year fellowship in occupational medicine, critical care, hyperbarics, pain, hospice, and addiction to completely change their practice environment and to an extent sports medicine and informatics too. Most residences will grant 6-12 months credit for completing a different residency. Otherwise a 3 year fellowship sounds like a second residency to me...
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CCM already has a lot of competition and midlevel encroachment. That's straight up out of the frying pan and into the fire
 
inthezone2 said:
2021​
2020​
2019​
2018​
2017​
2016​
Differential% Change in 5 yrs
EM
2840​
2665​
2488​
2278​
2047​
1895​
945​
49.86807388​

I crunched the numbers awhile back for EM. A 50% increase in spots over 5 years is absolutely devastating.
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Madness. An entire specialty's worth of increase over 5 years, with NO signs of slowing down.
 
also, lol...55% increase in em spots since 2015. Oh man.

edit; whoops. One second too late. I did the math right when you were i think

who the heck is in charge of this expansion? Who needs 2800 angry letters every year?
 
Backpack234 said:
EM exit strategies I know of so far

Without fellowship:
Telemedicine
Urgent Care
Wound Care
Start your own business with the above.

With fellowship:
Critical Care
Sports med
Pain med
And admin? Maybe?

anything I forgot? The options seem limited compared to other specialties
Click to expand...
Palliative care.

If you've got enough money in real estate or the stock market, you don't need anything else either.
Can do side gigs as a writer for question banks. Did that during residency. Start your own consulting gig where you help premeds get into medschool or med students prep their residency apps/interview.
 
If EM gets to the point of being critically oversaturated with salaries at rock bottom, what are the chances HCA and the other for-profit EM residencies just close down those programs, to benefit someone other than themselves?

It seems to me they're going to want to ride the Cheap Labor Horse as long and hard as they can.

What's ACEP/AAEM/ABEM's plan to avoid this?

What red-line in the sand have they put on total residency spots, total EM physician positions, they won't go over before drastic measures will be taken? And what are those measures?

What floor have they put on EP salaries, below which they would take drastic action, to benefit EPs? And what are those actions?

Is there a plan other than "IMPORT CHEAP LABOR AT ALL COSTS, IMPORT CHEAP LABOR AT ALL COSTS"?
 
dadaddadaBATMAN said:
Emergent, I have no specific problem with you, but I have been on this forum a long, long time, and wasted far too much time here.

I remember another doctor who was “whining” nonstop in the late 2000s despite making twice what we make and wanting to switch to radiology. It was you (I quoted the thread above).

So try to tap into that memory and have a little empathy for people who are feeling similar angst to what you did. Hopefully they find the same peace with the field that you eventually came to.
Click to expand...
hahahah
 
Birdstrike said:
If EM gets to the point of being critically oversaturated with salaries at rock bottom, what are the chances HCA and the other for-profit EM residencies just close down those programs, to benefit someone other than themselves?

It seems to me they're going to want to ride the Cheap Labor Horse as long and hard as they can.

What's ACEP/AAEM/ABEM's plan to avoid this?

What red-line in the sand have they put on total residency spots, total EM physician positions, they won't go over before drastic measures will be taken? And what are those measures?

What floor have they put on EP salaries, below which they would take drastic action, to benefit EPs? And what are those actions?

Is there a plan other than "IMPORT CHEAP LABOR AT ALL COSTS, IMPORT CHEAP LABOR AT ALL COSTS"?
Click to expand...
None of your questions require answers. We all know exactly what these monsters are thinking.
 
In 2015 there were about 300 EM DO matches. Still a big increase since that year but need to factor those into the above numbers.

Many of the old DO programs had to expand class sizes to become ACGME compliant as well.

We should be pushing for BCEM requirements for all non CAH.
 
Rekt said:
Of course not. We're about 840 overproduced. 2k spots flat is a fine number.


Is it possible to create an EM to FM fellowship? 100% serious.
Click to expand...
Just do what they do/did. Hang a shingle and be a PCP. maybe a weekend course? or not..
 
Backpack234 said:
EM exit strategies I know of so far

Without fellowship:
Telemedicine
Urgent Care
Wound Care
Start your own business with the above.

With fellowship:
Critical Care
Sports med
Pain med
And admin? Maybe?

anything I forgot? The options seem limited compared to other specialties
Click to expand...

bravotwozero said:
Palliative care.

If you've got enough money in real estate or the stock market, you don't need anything else either.
Can do side gigs as a writer for question banks. Did that during residency. Start your own consulting gig where you help premeds get into medschool or med students prep their residency apps/interview.
Click to expand...
Clinical Informatics, Occupational Medicine, and Addiction Medicine are other ACGME-accredited options.
 
Franzd'Epinay said:
Clinical Informatics, Occupational Medicine, and Addiction Medicine are other ACGME-accredited options.
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Going from EM into OCC Med would be a terrible transition. Take all the folks faking injuries to get off work, get on disability, and scam drugs and see just those folks(mixed in with a few real injuries) all day long. I would do correctional med or addiction med first. One of my medical directors is transitioning into a full time role in clinical informatics. Seems pretty cush if you like the work. Bankers hours, work from home, write your own job description, etc
 
skougess said:
Man screw this guy. Talking about job fairs as a fix to the job market. Yes, definitely, the problem right now is that physicians and employers just can’t find each other!
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What's he going to say? These guys of course know what the problem is, yet they are beholden to their CMG "Diamond donors" and can't rock the boat.
 
Look at Twitter. Snowflake med students who didn't match at their first choice are clamoring for more spots to open in everything. Do they not understand that outside of Stanford Plastics etc there is a job shortage?
 
miacomet said:
Look at Twitter. Snowflake med students who didn't match at their first choice are clamoring for more spots to open in everything. Do they not understand that outside of Stanford Plastics etc there is a job shortage?
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"Why would medical students who don't match (or who have friends who don't match) complain? Don't they realize that my depressed wages are more important than their ability to get licensed and practice medicine? Why can't they take one for the team and go into crushing debt without the ability to pay it back so that I can make $400/hr?"

Yeah, they're the snowflakes...
 
Franzd'Epinay said:
"Why would medical students who don't match (or who have friends who don't match) complain? Don't they realize that my depressed wages are more important than their ability to get licensed and practice medicine? Why can't they take one for the team and go into crushing debt without the ability to pay it back so that I can make $400/hr?"

Yeah, they're the snowflakes...
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Yes definitely the solution then is to expand residency positions so they can be unemployed 3 years later instead.
 
miacomet said:
Look at Twitter. Snowflake med students who didn't match at their first choice are clamoring for more spots to open in everything. Do they not understand that outside of Stanford Plastics etc there is a job shortage?
Click to expand...
They can clamor all they want, nobody is making a decision based off of their clamoring on twitter...
 
skougess said:
Yes definitely the solution then is to expand residency positions so they can be unemployed 3 years later instead.
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Yeah, let's take out our frustrations on the med students who just went through match week and either didn't match or have close friends who didn't match. They are definitely to blame for the increase in medical school seats and HCA residencies.

I bet you're the type of person who complains about kids who received participation trophies. Yes, the kids are definitely to blame there.
 
Franzd'Epinay said:
Yeah, let's take out our frustrations on the med students who just went through match week and either didn't match or have close friends who didn't match. They are definitely to blame for the increase in medical school seats and HCA residencies.

I bet you're the type of person who complains about kids who received participation trophies. Yes, the kids are definitely to blame there.
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First off, nobody blamed med students for this problem.

Second, any US MD/DO who passed their classes/steps and isn’t full blown autistic will eventually find a spot in some specialty somewhere. I feel terrible for those people who didn’t match, but they will still eventually find a spot as an attending if their expectation match reality. To say the solution is expand residencies to an unsustainable level (i.e. so they won’t have a job, or will have a terrible one after the grueling years of residency), I think it’s fair to say that is a misguided thought in a moment of frustration.
 
Franzd'Epinay said:
Yeah, let's take out our frustrations on the med students who just went through match week and either didn't match or have close friends who didn't match. They are definitely to blame for the increase in medical school seats and HCA residencies.

I bet you're the type of person who complains about kids who received participation trophies. Yes, the kids are definitely to blame there.
Click to expand...

My point is that med students are being sold a line, buying it because they are both gullible and think they are special, and and think the attending market is infinite, and thus things will probably get worse.
 
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