EM saturation

[shindog]

When I went home over spring break, I talked with an attending at the ED that I volunteered at. He mentioned that with over a 1,000 EM spots a year, the market is going to be quickly saturated. The number of EDs is remaining fairly constant. What are some of you upperclassmen and residents hearing? It makes sense that with a finite number of EDs, it only takes so many spots to staff them. Do you think they should lower the number of residency spots?

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[mikecwru]

Originally posted by shindog
When I went home over spring break, I talked with an attending at the ED that I volunteered at. He mentioned that with over a 1,000 EM spots a year, the market is going to be quickly saturated. The number of EDs is remaining fairly constant. What are some of you upperclassmen and residents hearing? It makes sense that with a finite number of EDs, it only takes so many spots to staff them. Do you think they should lower the number of residency spots?

Everything I have heard says that there will be a demand for EM well into 2020s, or through a significant portion of our careers.

mike

 

[shindog]

Originally posted by mikecwru
Everything I have heard says that there will be a demand for EM well into 2020s, or through a significant portion of our careers.

mike

Do you think that is because most EDs are "phasing out" general practioners and replacing them with EM trained physicians?

 

[ollaguna]

It's my understading that the days of working in an ED without having completed an EM residency are coming more and more to an end. Nothing against Internists or FP's that work in ED's (I've met some really great ED doc's with no formal EM training), but who would you rather have treat your emergency? Someone whos training completely revolved around the diagnosis and management of acute conditions, or someone who's training was geared towards long term management? Also, in this day in age, liability must play somewhat of a role. I can picture an attorney questioning a physican in court - "So Dr. Smith, you work in Emergency Department X, but in reality you have no formal training in emergency medicine?"

In regards to supply and demand, I think the future will hold a change in trends. Right now those statistics are based on a demand for formally trained EM Doc's (quantity). As classes graduate and staff ED's, the demand will of course decrease. However, with more and more people pursuing fellowships, soon the demands will shift from quantity to quality. Hospitals will look to hire EM Doc's with sub-specialties to match the patient population of the department.

I may be way off target, but that's my impression. Anyone else have any opinions on the topic?

 

[Iron Horse]

This is completely speculative, but my understanding is that there is a higher than average burn-out rate among EM docs. If that's true, the t/o rate for positions would also be higher meaning that positions would open up with greater frequency versus other MD positions.

Any truth (i.e. studies/stats) to support the burn-out question?

 

[Wrangler]

Excellent point. Demand is high and should be for a time (hopefully). We are pumping out a lot more EM docs. Non-EM trained will have a tougher and tougher time holding on and finding positions. But anesthesia ran into a similar problem with overstaffing a few years ago. Positions and pay dropped substantially, so they cut back. Now it has come back around for them, and things are wide open again. I really wish that we would stop opening up training slots and inventing programs all over the place, b/c it will only hurt the demand for our services in the end. I'd rather have a few FP's and IMD's working in our territory than EM docs scrambling for positions in small, rural ED's and fast-tracks. Overexpansion is BAD, but we might have to learn the hard way!!! It will still cycle back as anesthesia did though.

Sorry(not really) - just my worried rantings

 

[blackcat]

my understanding is that the burn out question was for non-em trained people early on in the life of em.
i haven't seen anything new about it.
i think since most em residents know what they are getting into, the burn out rate will be lower

 

[Chris_Topher]

Another consideration is the continued overutilization of the ER as a source of primary care. More and more PC and specialist docs are declining to accept medicare/aid patients, and these patients then come to the ED. I don't know if this has specifically affected the number of attending positions, but it may create a demand in the next 20 years.

 

[Sheerstress]

Not long ago, I spoke with the chair of EM at a nearby university. He said that at present, there are approximately 35,000 positions in EM nationwide, and of those positions, about 15,000 are made up of people actually boarded in emergency medicine.

One physician I know, who is director of EM at a small rural hospital recently asked some residency graduates (whom he was trying to recruit) how soon they thought it would be before most of those jobs were held by people BE or BC in EM. Their response was "not in our lifetime."

They indicated that while all the major EM organizations are always looking to make more and more EM residency-trained practitioners the sole providers in EDs nationwide, most of these graduates gravitate toward major urban and suburban areas, where the best jobs are available. It's mostly the rural hospital jobs that continue to go unfilled except by PCPs willing to step in.

 

[shindog]

Originally posted by Sheerstress
Not long ago, I spoke with the chair of EM at a nearby university. He said that at present, there are approximately 35,000 positions in EM nationwide, and of those positions, about 15,000 are made up of people actually boarded in emergency medicine.

One physician I know, who is director of EM at a small rural hospital recently asked some residency graduates (whom he was trying to recruit) how soon they thought it would be before most of those jobs were held by people BE or BC in EM. Their response was "not in our lifetime."

They indicated that while all the major EM organizations are always looking to make more and more EM residency-trained practitioners the sole providers in EDs nationwide, most of these graduates gravitate toward major urban and suburban areas, where the best jobs are available. It's mostly the rural hospital jobs that continue to go unfilled except by PCPs willing to step in.

The attending I spoke with brought this up as well. I doubt this will change until/if/when salaries at the rural hospitals catch up to those in highly populated areas.