EM really that competitive??

[jaz]

---

Members don't see this ad.

I have recently read in Iserson and others that Em is rising in competitiveness. He compares EM to derm and ortho. I have freinds that have matched to EM with good but not ortho or derm type numbers. They seem to think otherwise. Any info?

 

[bigfrank]

Hi there,

In terms of competiveness, EM is nowhere near Derm/Ortho/Ophtho/etc. This is for several reasons:

1. EM has ~ 1,200 spots per year.
2. EM is not seen as "prestigious" as the other fields mentioned.
3. EM (generally) does not have the income potential that is commonly associated with the other mentioned specialties.
4. EM (though a great lifestyle in terms of HOURS worked) does not have the insanely good lifestyle that Derm and Ophtho have.

Generally, a US-MD that applies to enough programs and does not limit himself/herself geographically will match somewhere. In fact, roughly 1/10 EM residents in the US are DO's. While this is in no way meant to be be an anti-DO comment, it is interesting to note this. The other specialties have < 1% DO.

Frank

 

[DrMom]

A huge percentage of my class (1/3 or so) is currently planning on EM! Since it is still early on in the game, I'm hoping that some of them change their minds so that I don't have so much competition!!! 😉

 

[Ca$h MaNi]

Considering that DO's primarily seek to enter into primary care....it should be noted that the number of DO's in any of these "competitive" residencies have no bearing on if it is "real competitive" or not. DO's are trained in primary care first, then specialists second...

Also the fact that there are more med schools pumping out allopathic physicians versus osteopathic physicians will always show up less in numbers in any statistic...

 

[ckplay]

Originally posted by jaz
I have recently read in Iserson and others that Em is rising in competitiveness. He compares EM to derm and ortho. I have freinds that have matched to EM with good but not ortho or derm type numbers. They seem to think otherwise. Any info?

EM was rising in competitiveness during the late 90's. Now I would say it's declining or in a plateau phase. It's still in the "less competitive" group, however.

Not Competitive:
FP (declining, if that's possible)
Psych - stable
[pass step 1, mostly FMG/DO]

Less Competitive:
IM - stable
EM - stable
OB- declining fast
Peds - stable
Anes - rising
Neuro - stable
PM&R - stable/rising
Path- rising
[US grad, pass step 1; IM & Peds have a huge range from not competitive to very competitive programs]

Competitive:
Rad - rising
Gen Surg - declining
Ophthal - declining
[US grad, step 1 > 220]

Very Competitive:
Derm - stable
Rad-onc - rising
Plastic Surg - rising
Neuro Surg - declining
Ortho - rising
Urology - stable
[US grad, step 1 >235]

 

[Mike59]

Originally posted by ckplay
Not Competitive:
FP (declining, if that's possible)

Is there any logical reason for this outside of salary or lack or prestige?

I'm looking forward to my FP rotations and am pretty sure that's what I want to do. Is their anything terribly wrong with being a family doc at this time that explains why med students avoid FP like the plague?

 

[tega]

Originally posted by ckplay
EM was rising in competitiveness during the late 90's. Now I would say it's declining or in a plateau phase. It's still in the "less competitive" group, however.

Not Competitive:
FP (declining, if that's possible)
Psych - stable
[pass step 1, mostly FMG/DO]

Less Competitive:
IM - stable
EM - stable
OB- declining fast
Peds - stable
Anes - rising
Neuro - stable
PM&R - stable/rising
Path- rising
[US grad, pass step 1; IM & Peds have a huge range from not competitive to very competitive programs]

Competitive:
Rad - rising
Gen Surg - declining
Ophthal - declining
[US grad, step 1 > 220]

Very Competitive:
Derm - stable
Rad-onc - rising
Plastic Surg - rising
Neuro Surg - declining
Ortho - rising
Urology - stable
[US grad, step 1 >235]

i would have thought neurology would be more competitive.

 

[ckplay]

Partly it's the money, but that doesn't explain why Peds is more competitive than FP.

1. Money
2. Prestige (or lack there of)
3. Few fellowships
4. Few good training programs
5. OB/Surg rotations
6. Intellectually not stimulating. Unless you're working in a rural area, you refer every interesting pt to a subspecialist.
7. High percentage of FMGs. I think many US grads have a complex.
8. Trend towards more PAs/NPs. It has be a blow to the ego when you are told that you can be replaced by someone with less IQ and education.

 

[rbassdo]

Originally posted by Mike59
Is there any logical reason for this outside of salary or lack or prestige?

I'm looking forward to my FP rotations and am pretty sure that's what I want to do. Is their anything terribly wrong with being a family doc at this time that explains why med students avoid FP like the plague?

Hey Mike59,

I mean absolutely no personal disrespect to those who desire to be FP's. Some of my best friends at KCOM are aspiring FP's. Nevertheless, in light of modern times and changes (ie - the prevelance and increasing roles of PA's and Nurse Practitioners), I truly see very little different between what FP's do and what PA's or NP's do. Sure...the doc has the ultimate responsibility in some situations, but in day to day office practice, there's hardly a difference. I hear people say things such as, "I'm going to see my NP," or, "my PA." In other words, citizens know what's going on and many realize that much of their primary care may be provided by a PA or NP.

I truly believe that FP's will be basically obsolete in the office scene. HMO's and the ever-continuing shift towards socialistic medicine, in this country, will ensure that.

If I were interested in doing "office based" primary care, I'd at least do internal medicine or try to get into a med/peds residency. In that position, it's going to be much harder for PA's or NP's to "steal" your role - especially in the hospital. Remember, FP's used to deliver babies, do their own lab work, and see ALL their patients, and even deliver an occasional horse or cow. Where has all that gone? See above + OB + Path, etc. What's next?

 

[Castro Viejo]

Originally posted by jaz
I have recently read in Iserson and others that Em is rising in competitiveness. He compares EM to derm and ortho. I have freinds that have matched to EM with good but not ortho or derm type numbers. They seem to think otherwise. Any info?

Iserson is pretty biased towards his own profession, and since the first edition of his book, back in 1993, he's been writing how EM is as competitive as perennial favorites like Dermatology and Orthopedics. He's a bit delusional and I quite honestly don't like his book at all (although I did read the thing from cover to cover in my senior year of college to "prepare" for med school).

I would take whatever he writes with a grain of salt.

 

[womansurg]

Man it's soooo cyclical. A scant ten years ago when I was an undergrad and talking to docs in the ED where I worked, the scoop was that ED work was considered dirty scut which paid like poo, had no prestige, and was performed by docs who couldn't quite cut it in the real world of medicine. Amazing what a successful television series can accomplish.

 

[ckplay]

PA/NPs will never "steal" an MD's role. The only reason PA/NPs exist is because there is a shortage of primary care providers and because greedy docs wanted help for cheap.

If you really want to do FP, go for it...I wouldn't worry about PA/NPs taking over. No one with an IQ >70 would see a PA/NP for anything except to get a prescription for allergy Rx.

 

[Castro Viejo]

Originally posted by womansurg
A scant ten years ago when I was an undergrad and talking to docs in the ED where I worked, the scoop was that ED work was considered dirty scut which paid like poo, had no prestige, and was performed by docs who couldn't quite cut it in the real world of medicine.

So what's changed? 😛

 

[carrigallen]

Originally posted by ckplay
EM was rising in competitiveness during the late 90's. Now I would say it's declining or in a plateau phase. It's still in the "less competitive" group, however.

Not Competitive:
FP (declining, if that's possible)
Psych - stable
[pass step 1, mostly FMG/DO]

Less Competitive:
IM - stable
EM - stable
OB- declining fast
Peds - stable
Anes - rising
Neuro - stable
PM&R - stable/rising
Path- rising
[US grad, pass step 1; IM & Peds have a huge range from not competitive to very competitive programs]

Competitive:
Rad - rising
Gen Surg - declining
Ophthal - declining
[US grad, step 1 > 220]

Very Competitive:
Derm - stable
Rad-onc - rising
Plastic Surg - rising
Neuro Surg - declining
Ortho - rising
Urology - stable
[US grad, step 1 >235]

hmm, i'd add a few suggestions in your listings.
#1 Gen Surg may be in the "less competitive" now
#2 IM really varies, tho if u just want to go anywhere it's easy
#3 Maybe Anes is almost in the competitive now
#4 Maybe stick Med-Peds in there somewhere
#5 How about doing one for fellowships??
#6 You're missing ENT/Otol - probably stick in competitive - stable

 

[WatchingWaiting]

Are you sure "cyclical" is the right term? I think neurosurgery, cardiothoracic surgery have been extremely competetive since their inception as specialties, and most of the other surgical specialties have been highly competive throughout. Surgery in general (esp. gen surgery) has been taking a hit to its competetiveness over the last few decades, but this is well correlated with the rise in popularity of lifestyle-positive specialties, like opthamology, dermatology, radiology.

There's basically been a long-term trend over the last twenty+ years, due largely to the equalization of representation in medicine between men and women, towards emphasizing quality of life in specialty selection, and this explains many of the shifts in specialty popularity.

The other change is due to financial shifts in medicine, especially wrt certain fields-- for example, pathology was largely destroyed as a competetive specialty due to hospital consolidation and subsequent massive cutting of the need for pathologists, coupled with overproduction of pathologists. I'm not sure how psychiatry salaries got annihalated, but I think its presence as a non-competive specialty is also mostly due to the very low salaries associated with it as a specialty.

Anyway, given the very short relative period of time over which the idea of medical specialties has existed, and the lack of cycling of popular fields (it's not like neurosurgery has ever not been extremely competetive, or psychiatry has gone from popular to unpopular to popular to unpopular: I think you'd be hard pressed to name more than a couple of specialties whose popularity could be characterized as cyclcial), I don't think cyclical is the right term.

 

[maxheadroom]

True, NeuroSurg is and probably always will be very competitive, but CT is genuinely in decline. The best/brightest GenSurg graduates who pursue fellowships seem to be moving CT.

I'd also argue that, while GenSurg has been on the decline, this year probably marks an upswing. Hopefully the trend will continue.

 

[Castro Viejo]

Originally posted by carrigallen
hmm, i'd add a few suggestions in your listings.
#1 Gen Surg may be in the "less competitive" now
#2 IM really varies, tho if u just want to go anywhere it's easy

Uhm, your logic for #2 may very well be applicable to General Surgery. Or are you just trying to say that getting into General Surgery anywhere is "less competitive" than it was several years ago?

As far as the NRMP numbers go, General Surgery actually received more applications this year than last and had fewer open categorical positions.

 

[womansurg]

Originally posted by carrigallen
#1 Gen Surg may be in the "less competitive" now

Maybe you haven't been keeping up with current events, Maaaaaan...

sorry, I really loved the movie 'Aliens'

Actually, the dip in surgery applications resolved in a resounding way over the past application cycle. Face it, general surgery is just the coolest job on the planet. It's always going to be popular. Especially now that focus on lifestyle is being imposed by the ACGME.

 

[Castro Viejo]

Originally posted by womansurg
Actually, the dip in surgery applications resolved in a resounding way over the past application cycle. Face it, general surgery is just the coolest job on the planet.

Amen, sister.

 

[rbassdo]

Originally posted by ckplay
No one with an IQ >70 would see a PA/NP for anything except to get a prescription for allergy Rx.

What about the millions of people who don't have a choice (HMO's)?

By the way, where I come from, PA's are doing flex sigs, colonoscopies, arteriograms, etc. unsupervised. They can do a bit more than prescribe allergy medicine - don't flatter yourself (assuming you're a med. student).

 

[DuneHog]

Originally posted by rbassdo
What about the millions of people who don't have a choice (HMO's)?

By the way, where I come from, PA's are doing flex sigs, colonoscopies, arteriograms, etc. unsupervised. They can do a bit more than prescribe allergy medicine - don't flatter yourself (assuming you're a med. student).

I could see that one coming a mile away...

 

[ckplay]

Originally posted by rbassdo
What about the millions of people who don't have a choice (HMO's)?

By the way, where I come from, PA's are doing flex sigs, colonoscopies, arteriograms, etc. unsupervised. They can do a bit more than prescribe allergy medicine - don't flatter yourself (assuming you're a med. student).

You must come from Mars. No PA does anything unsupervised! I don't mind the PAs doing mindless procedures - some may even have better hand-eye coordination. Leave the thinking to the MDs (like me, in 2 weeks!).

 

[ckplay]

Originally posted by carrigallen
hmm, i'd add a few suggestions in your listings.
#1 Gen Surg may be in the "less competitive" now
#2 IM really varies, tho if u just want to go anywhere it's easy
#3 Maybe Anes is almost in the competitive now
#4 Maybe stick Med-Peds in there somewhere
#5 How about doing one for fellowships??
#6 You're missing ENT/Otol - probably stick in competitive - stable

 

[ckplay]

Originally posted by carrigallen
hmm, i'd add a few suggestions in your listings.
#1 Gen Surg may be in the "less competitive" now
#2 IM really varies, tho if u just want to go anywhere it's easy
#3 Maybe Anes is almost in the competitive now
#4 Maybe stick Med-Peds in there somewhere
#5 How about doing one for fellowships??
#6 You're missing ENT/Otol - probably stick in competitive - stable

Gen Surg has been in decline for a few years (with the exception of this year). Varies quite a bit like IM, but in general more competitive than any of the specialties I listed in the less competitive group.

Anesthesia just graduated from the "not competitive" (actually the cellar) group not so long ago, and although there's been an exponential surge in interest the past 2-3 years and a lot of hype from the gas people, it's still relatively easy to match for a US grad. (If NYCOM can match 26 in anesthesia, it can't be that tough).

Med-Peds goes in the less competitive group, with rising interest.

Agrees, ENT competitive & stable.

 

[deleted6669]

CKPLAY-the legal definition of supervision for pa's in most states is cosignature on charts within a month. I work solo in an E.D. where my supervising doc signs 10% of my charts within 1 month(the minimum state requirement). I reduce fractures, do septic workups on babies and workup elderly folks with chest pain. I have been working in emergency medicine for over 16 years including 2 years teaching at an md fp residency program. check out www.aapa.org for a little reality check if you think all pa's do is treat allergies with direct supervision.

 

[ckplay]

Originally posted by emedpa
CKPLAY-the legal definition of supervision for pa's in most states is cosignature on charts within a month. I work solo in an E.D. where my supervising doc signs 10% of my charts within 1 month(the minimum state requirement). I reduce fractures, do septic workups on babies and workup elderly folks with chest pain. I have been working in emergency medicine for over 16 years including 2 years teaching at an md fp residency program. check out www.aapa.org for a little reality check if you think all pa's do is treat allergies with direct supervision.

I'm sorry, but that is SCARY! Just curious, where is this ED?

I know PAs can do more, but my point was that most people with a choice would not waste their time with a PA.

 

[DrMom]

Originally posted by ckplay
I know PAs can do more, but my point was that most people with a choice would not waste their time with a PA.

Just like any profession, you'll find great PAs and less than stellar ones. Keep in mind that Drs are no different.

I have seen one PA who I found to be highly competent. I would go back without hesitation. I haven't had the opportunity to be treated by any others.

 

[deleted6669]

CK-WASHINGTON STATE.
PA'S WORK SOLO IN ED'S IN WASHINGTON, OREGON, VERMONT, MAINE, NEW HAMPSHIRE, ARIZONA, TEXAS, GEORGIA AND A NUMBER OF OTHER STATES. WE HAVE PHYSICIAN BACKUP AVAILABLE WITHIN 10-20 MIN AND ARE REQUIRED TO BE PROFICIENT IN ACLS/ATLS/PALS. MANY OF US(MYSELF INCLUDED) ARE INSTRUCTORS IN 1 OR MORE OF THESE COURSES. MOST PA'S WHO DO THIS HAVE SIGNIFICANT EXPERIENCE AND/OR POSTGRADUATE TRAINING. I WAS A PARAMEDIC FOR 5 YEARS BEFORE PA SCHOOL AND DID A FELLOWSHIP IN EMERGENCY MED FOR A YEAR AFTER GRADUATION. I AGREE THAT A RESIDENCY TRAINED EMERGENCY PHYSICIAN PROVIDES A HIGHER LEVEL OF SERVICE, BUT THERE CURRENTLY ARE NOT ENOUGH OF THESE FOLKS TO GO AROUND SO PA'S AND FP DOCS FILL IN THE GAPS.

DR MOM-THANKS FOR THE NICE COMMENT! WHEN AND IF I GO BACK TO MED SCHOOL IT WILL BE A D.O. PROGRAM BECAUSE OF THE PREPONDERANCE OF OPEN MINDED PEOPLE LIKE YOURSELF

 

[mikecwru]

Originally posted by emedpa
DR MOM-THANKS FOR THE NICE COMMENT! WHEN AND IF I GO BACK TO MED SCHOOL IT WILL BE A D.O. PROGRAM BECAUSE OF THE PREPONDERANCE OF OPEN MINDED PEOPLE LIKE YOURSELF

Now, Now, you're being a close minded jerk with this statement just like him. Not every MD thinks the same way of PAs as this guy. It's sad that someone can graduate from med school without some modicum of humility.

mike

 

[Freeeedom!]

The biggest problem I have seen in my region of the midwest is that the old addage that a PA required some sort of previous medical experience is "out the window". These "kids" graduate with a BS and are maybe 21...I pimp them (in their last month of training) and they can't tell me how to read an EKG if the rhythm is sinus or fib or even the basics of the dermatomal distribution of the legs.
The problems "churning out" midlevels will soon reach epidemic proportions...and they simply won't be the high level ones like Emedpa, rather kids that simply didn't want all the school of medschool. It really is bad where I am...
I have worked with some great experienced PA's (and where I am from each and every patient must be checked in with the attending), but I think the applicant field has changed, and NOT for the better.

 

[Castro Viejo]

Originally posted by rbassdo
By the way, where I come from, PA's are doing flex sigs, colonoscopies, arteriograms, etc. unsupervised. They can do a bit more than prescribe allergy medicine - don't flatter yourself (assuming you're a med. student).

Regardless of what some are allowed to do, I think that's poor medical practice on the part of the attending (I believe there must be an MD or DO supervising a PA) and on the part of the PA.

Everyone has a role in healthcare and to overstep those boundaries is ultimately dangerous for the patiet. Forget about hurt egos and turf wars -- what about the patient?

 

[tBw]

Originally posted by pba
also, the top medicine programs are harder than getting laid at 15.

i got laid at 15, does this mean i am set?

 

[deleted6669]

MIKE-of course you are correct. I apologize to all rational colleagues out there, md or otherwise.

freedom-good to see you back. hope intern year was good to you. I agree with you about the new crop of 22 year old pa grads. they are a scary bunch.....

 

[womansurg]

Originally posted by pba
and no, womansurg, the interest in ED doesnt reflct a goddamn tv series.

Nice.

Actually I beg to differ. When my good friend was applying to EM programs, she had many discussions with residents and PDs re: how the popularity of 'ER' had contributed to the surge in EM applicants at that time. Although today it seems to be considered gauche today for students to admit being influenced by popular culture in their interest in medicine (based on the responses on this board), at that time 'ER' was novel and cutting edge. People freely spoke of how they had not considered EM until they were exposed to the series.