Emergency Medicine Physician Shortage or Surplus?

[texhess]

Hi-

I’m about to start my first semester in medical school, I understand that it’s a time to learn & try out a bunch of different specialties but ever since I was a kid, I was struck with an interest in EM.

As of late, I’ve read articles which suggest a major shortage in physicians throughout the US, especially in regards to EM, but I’ve also read a bunch of articles claiming there will be a surplus of EM physicians by 2030.

Was wondering what other’s takes were regarding this topic, I get COVID changed a great deal about medicine, but it seems surprising to me for the claims to go polar-opposite.

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[GeneralVeers]

The first (surplus) of doctors is propaganda used to start more training programs and drive down labor cost.

The second is true. We will have an oversupply of EM physicians, and likely doctors in general in the next 10 years.

 

[bravotwozero]

Hi-

I’m about to start my first semester in medical school, I understand that it’s a time to learn & try out a bunch of different specialties but ever since I was a kid, I was struck with an interest in EM.

As of late, I’ve read articles which suggest a major shortage in physicians throughout the US, especially in regards to EM, but I’ve also read a bunch of articles claiming there will be a surplus of EM physicians by 2030.

Was wondering what other’s takes were regarding this topic, I get COVID changed a great deal about medicine, but it seems surprising to me for the claims to go polar-opposite.

There already is a surplus of physicians in most specialties. This is more so the case in EM. Physician shortage is an urban legend now.

 

[namethatsmell]

Nobody has a crystal ball on EM's future. But read the bajillion recent threads/posts about this exact subject on this forum. With good reason, most here think the outlook is grim.

IMHO the best thing you can do is take your "interest in EM," put it in your back pocket, and truly try to get interested about every field you come into contact with in the next ~3 years before you have to pick one. Recognize that medical student rotations in EM shields students from most of the worst aspects of the field, unlike surgical fields where rotating students tend to experience the worst aspects of those fields (ie scut). Not saying don't go into EM, but you'd better 10000% sure there's nothing else you'd rather do since the future for EM appears bleak.

Here's the best advice for a new medical student: unless your soul demands that you do a specific field that happens to only be hospital-based (ie trauma surg, EM, crit care etc)...pick a field that will give you options to work fully outside the confines of a hospital and/or potentially open up your own practice. Given the current trajectory of the business of medicine, this is the path to having the greatest freedom and control over your work life. And having freedom and control once you're an attending is one of the surest ways to improve the odds of you having long-term career satisfaction and longevity.

 

[Birdstrike]

Hi-

I’m about to start my first semester in medical school, I understand that it’s a time to learn & try out a bunch of different specialties but ever since I was a kid, I was struck with an interest in EM.

As of late, I’ve read articles which suggest a major shortage in physicians throughout the US, especially in regards to EM, but I’ve also read a bunch of articles claiming there will be a surplus of EM physicians by 2030.

Was wondering what other’s takes were regarding this topic, I get COVID changed a great deal about medicine, but it seems surprising to me for the claims to go polar-opposite.

Ignore the swinging pendulum of specialty shortages and surpluses in making your specialty choice. Choose a specialty where you don't work any nights, weekends, holidays or take call. No amount of "interest" or "job enjoyment" you think you might get out of a specialty enough to compensate for what those sacrifices take from you. Mark my words.

 

[skougess]

The “shortage” is AAMC, ACGME propaganda. AAMC sends me an email about helping to lobby Congress about this “issue” nearly monthly. It’s an insult to my intelligence they would send this to a physician and not a starry eyed premed/med student.

 

[MechEDoc]

Hospital systems are pretty much a cancer on health care. The two sides of the evil coin are insurers (charge for "coverage" and then minimize the actual coverage) and health care systems (maximal billing, lowest labor costs). Try to find a field that will let you work outside a hospital system - ophthalmology, FM/IM/peds, etc.

 

[gamerEMdoc]

One of the problem with some of these "underserved" outlooks is that it looks at things on a national, not regional level. There are still areas of the country that are underserved in just about every field. But those are also areas of the country that many physicians don't want to live. In the places that most physicians want to live, there has been a surplus of physicians for awhile.

 

[texhess]

One of the problem with some of these "underserved" outlooks is that it looks at things on a national, not regional level. There are still areas of the country that are underserved in just about every field. But those are also areas of the country that many physicians don't want to live. In the places that most physicians want to live, there has been a surplus of physicians for awhile.

Makes sense, this is somewhat what I figured. If the market is saturated, just move. Hopefully it will be a decent place. Thanks for the insight!

 

[GeneralVeers]

Makes sense, this is somewhat what I figured. If the market is saturated, just move. Hopefully it will be a decent place. Thanks for the insight!

The problem with supply and demand is that we don't have proper market forces at work. Normally an area with shortage would pay doctors a lot more to attract doctors. I've seen many "critical access" rural hospitals pay $150/hr or less. They need to be paying $400/hr if they want to attract physicians to these areas.

 

[HoosierdaddyO]

Yea but when you have these shot hole residencies popping up with under qualified applicants. They will pay you what they want to pay you and you better damn well be happy about it lol. No joke the crappiest community hospital I’ve ever known just took 10 new er interns as there new class for their new EM program, all from overseas graduates. The name of the hospital… wait for this… Community Medical Center in Toms River New Jersey lol. This whole ACGME thing has become such a freaking joke and it ain’t stopping in anytime.

 

[wendalltwolf]

The problem with supply and demand is that we don't have proper market forces at work. Normally an area with shortage would pay doctors a lot more to attract doctors. I've seen many "critical access" rural hospitals pay $150/hr or less. They need to be paying $400/hr if they want to attract physicians to these areas.

Also don’t forget that docs with families will need good school systems in those rural areas. Hopefully broadband internet will be available, or else you might have to mount a Starlink dish To your car like this guy:

 

[Apollyon]

The problem with supply and demand is that we don't have proper market forces at work. Normally an area with shortage would pay doctors a lot more to attract doctors. I've seen many "critical access" rural hospitals pay $150/hr or less. They need to be paying $400/hr if they want to attract physicians to these areas.

UPMC is very good for this underpayment.

 

[RustedFox]

Makes sense, this is somewhat what I figured. If the market is saturated, just move. Hopefully it will be a decent place. Thanks for the insight!

While I appreciate the question that you posed; "just move" isn't really that simple at all in a lot of cases.

 

[texhess]

While I appreciate the question that you posed; "just move" isn't really that simple at all in a lot of cases.

Well I am speaking from the perspective of a medical student: I 100% could imagine that would not necessarily be the case for a seasoned physician. Personally though, I am willing to take whatever opportunity presents itself, especially if it is in a potentially saturated job market

 

[RustedFox]

Well I am speaking from the perspective of a medical student: I 100% could imagine that would not necessarily be the case for a seasoned physician. Personally though, I am willing to take whatever opportunity presents itself, especially if it is in a potentially saturated job market

I like you.

Hey, guys... This one has a bright future.

 

[MechEDoc]

I like you.

Hey, guys... This one has a bright future.

I envision a future in telemedicine, urgent care, or corrections. Good luck seeing the inside of a real ER... 🙁

 

[sylvanthus]

Well I am speaking from the perspective of a medical student: I 100% could imagine that would not necessarily be the case for a seasoned physician. Personally though, I am willing to take whatever opportunity presents itself, especially if it is in a potentially saturated job market

TeamHealth will be glad to have ya for that sweet sweet pay.

 

[turkeyjerky]

TeamHealth will be glad to have ya for that sweet sweet pay.

Minimum wage maybe??

 

[RustedFox]

I like you.

Hey, guys... This one has a bright future.

Hold up.
I mis-read the post AGAIN.

"ANY opportunity, even in a saturated market?!"

I mean, you get points for coming here and listening with open ears and NOT trying to tell a battalion of ER docs that they're all wrong (like so many others have done), buy I would rethink "ANY opportunity, even in a saturated market".

There's a better life outside the ER given so many circumstances.

 

[texhess]

Hold up.
I mis-read the post AGAIN.

"ANY opportunity, even in a saturated market?!"

I mean, you get points for coming here and listening with open ears and NOT trying to tell a battalion of ER docs that they're all wrong (like so many others have done), buy I would rethink "ANY opportunity, even in a saturated market".

There's a better life outside the ER given so many circumstances.

Oh yeah, within a scope of reason, I would take what opportunities present themselves.

I probably should have been more specific than saying "any". Time will tell with how the ER field goes. But certainly, if things seem bleak, it would be time to consider other options -- I've got a couple of years to see how things go and test out the water -- I am of course all ears though for advice though!

I appreciate it!

 

[RustedFox]

Oh yeah, within a scope of reason, I would take what opportunities present themselves.

I probably should have been more specific than saying "any". Time will tell with how the ER field goes. But certainly, if things seem bleak, it would be time to consider other options -- I've got a couple of years to see how things go and test out the water -- I am of course all ears though for advice though!

I appreciate it!

Okay.

I like you.

Hey guys... this one's got a bright future.

 

[texhess]

Okay.

I like you.

Hey guys... this one's got a bright future.

Haha, I appreciate it!

 

[gamerEMdoc]

UPMC is very good for this underpayment.

Truth

 

[collegestud2013]

There already is a surplus of physicians in most specialties. This is more so the case in EM. Physician shortage is an urban legend now.

Does anyone here actually know someone in EM this year, especially a new or recent grad, who was actually unable find a job at all working in an ED due to the surplus (unemployed) or underemployed? For example, grads being forced to to do a fellowship that they wouldn't have otherwise done, doing clinical work not typically done by EM grads, or choosing to work outside clinical medicine?

Most of the posts on here suggest that the surplus is largely a distribution problem as a result of many grads not being geographically flexible enough or refusing to take a job that doesn't meet all their requirements. For now it sounds like the EM market is tighter but almost all grads can still get a job working in an ED if they are willing to move ANYWHERE in the U.S. (especially the rural areas where there is mostly a shortage) and take a job with less-than-ideal conditions.

 

[skougess]

Does anyone here actually know someone in EM this year, especially a new or recent grad, who was actually unable find a job at all working in an ED due to the surplus (unemployed) or underemployed? For example, grads being forced to to do a fellowship that they wouldn't have otherwise done, doing clinical work not typically done by EM grads, or choosing to work outside clinical medicine?

Most of the posts on here suggest that the surplus is largely a distribution problem as a result of many grads not being geographically flexible enough or refusing to take a job that doesn't meet all their requirements. For now it sounds like the EM market is tighter but almost all grads can still get a job working in an ED if they are willing to move ANYWHERE in the U.S. (especially the rural areas where there is mostly a shortage) and take a job with less-than-ideal conditions.

Just so we’re clear. The job market isn’t bad at long as there is at least one open job, somewhere in the United States, regardless of pay or conditions? That seems to be the argument you’re making

 

[GeneralVeers]

If you have to take a job in Nowhere, AL at $150/hr then the job market is saturated. At those rates, it's not even worth working someplace you aren't happy to be.

 

[sylvanthus]

Does anyone here actually know someone in EM this year, especially a new or recent grad, who was actually unable find a job at all working in an ED due to the surplus (unemployed) or underemployed? For example, grads being forced to to do a fellowship that they wouldn't have otherwise done, doing clinical work not typically done by EM grads, or choosing to work outside clinical medicine?

Most of the posts on here suggest that the surplus is largely a distribution problem as a result of many grads not being geographically flexible enough or refusing to take a job that doesn't meet all their requirements. For now it sounds like the EM market is tighter but almost all grads can still get a job working in an ED if they are willing to move ANYWHERE in the U.S. (especially the rural areas where there is mostly a shortage) and take a job with less-than-ideal conditions.

Yaa, putting in a decade of work, 100s of thousands on dollars of debt to work in rural arkansas is great. No issues guys, stop bitching about the market, all is well!

 

[Brigade4Radiant]

Does anyone here actually know someone in EM this year, especially a new or recent grad, who was actually unable find a job at all working in an ED due to the surplus (unemployed) or underemployed? For example, grads being forced to to do a fellowship that they wouldn't have otherwise done, doing clinical work not typically done by EM grads, or choosing to work outside clinical medicine?

Most of the posts on here suggest that the surplus is largely a distribution problem as a result of many grads not being geographically flexible enough or refusing to take a job that doesn't meet all their requirements. For now it sounds like the EM market is tighter but almost all grads can still get a job working in an ED if they are willing to move ANYWHERE in the U.S. (especially the rural areas where there is mostly a shortage) and take a job with less-than-ideal conditions.

Well if you have a spouse they have also suffered. Location matters a lot. If you did 7 years of post college training while working harder than most people in college just to barely find a job and to put your spouse through all that hardship any reasonable person would feel a way.

Many would rather be a Ortho PA working in LA or Denver than be a Neurosurgeon working in South Dakota.

 

[timpview]

Agree with the above

If it was me again:

1. Avoid specialties with Nights/heavy call. It takes years off your life. Try to avoid at all costs
2. Avoid Specialties dependent on hospital employment or are hospital based.

 

[bravotwozero]

One of my favorite columnists in Emergency Medicine News is Edwin Leap. I've been reading his column for years. That guy keeps it real, and never pulls punches when it comes to calling out bad actors/dumb policies that make the EP's life difficult. Still, he's someone i'd put in the optimist camp. His latest piece on the EM job market is pretty blunt and dead on, IMO. If this guy is saying he's worried, watch out folks.

Life in Emergistan: The Dark Age of Job Scarcity and Zero Leverage

 

[The Knife & Gun Club]

Does anyone here actually know someone in EM this year, especially a new or recent grad, who was actually unable find a job at all working in an ED due to the surplus (unemployed) or underemployed? For example, grads being forced to to do a fellowship that they wouldn't have otherwise done, doing clinical work not typically done by EM grads, or choosing to work outside clinical medicine?

Most of the posts on here suggest that the surplus is largely a distribution problem as a result of many grads not being geographically flexible enough or refusing to take a job that doesn't meet all their requirements. For now it sounds like the EM market is tighter but almost all grads can still get a job working in an ED if they are willing to move ANYWHERE in the U.S. (especially the rural areas where there is mostly a shortage) and take a job with less-than-ideal conditions.

Yes I know 4 people in that situation. One working urgent care for $90/hr in NYC, and 3 doing useless fellowships away from family and their support network, just to have something to do.

Also 2 people who left EM entirely and went to work finance/consulting. In one guys words “PE has already destroyed most of the world. There’s a little bit left to squeeze so maybe I can have health insurance and send my kids to college eventually. I don’t care anymore who I **** over, I just want to put food on the table”

 

[Birdstrike]

In one guys words “PE has already destroyed most of the world. There’s a little bit left to squeeze so maybe I can have health insurance and send my kids to college eventually. I don’t care anymore who I **** over, I just want to put food on the table”

Sounds like a heartwarming chap.

 

[Birdstrike]

Agree with the above

If it was me again:

1. Avoid specialties with Nights/heavy call. It takes years off your life. Try to avoid at all costs
2. Avoid Specialties dependent on hospital employment or are hospital based.

So much hard earned wisdom here.

 

[Brigade4Radiant]

One of my favorite columnists in Emergency Medicine News is Edwin Leap. I've been reading his column for years. That guy keeps it real, and never pulls punches when it comes to calling out bad actors/dumb policies that make the EP's life difficult. Still, he's someone i'd put in the optimist camp. His latest piece on the EM job market is pretty blunt and dead on, IMO. If this guy is saying he's worried, watch out folks.

Life in Emergistan: The Dark Age of Job Scarcity and Zero Leverage

Our ED director told us what we need to get our Press Ganey up or we may be "returned to the community" another doctor was basically told that they should stop complaining because they are replaceable by the CMG.

A lot of grads are calling ED's looking for work the CMGs know this since they control ACEP. Small Demorcatic groups will now work you like a CMG because they know the hospital can replace them easily.

 

[Birdstrike]

Society has broken it's moral contract with physicians, especially Emergency Physicians.

It's long past time for physicians to notice and make the necessary adjustments. If society no longer treats and views us as honored, revered and highly valued members of society, and now views and treats us as mere "replaceable cogs," highly paid "hot-dog vendors" to the hospitals, then it no longer makes sense to make traditional physician sacrifices. It no longer justifies being away from the family during nights, weekends and holidays, or to accept intrusive on-call responsibilities. It makes no sense to allow yourself to be threatened with job loss over the trivial, without so much as a "thank you" for a life saved. Make your plans now. This stuff is only going to get worse.

Society asked for it to be this way. There will be consequences.

 

[GeneralVeers]

Exactly. They've broken their contract to treat us with respect, deference and be polite. Administration and hospitals broke their contract to allow us to practice autonomously with our own judgement. Therefore I'm free to treat the patients like widgets, and not do one ounce of extra work to support a hostile administration.

 

[Kryptocoin]

With the job market the way it is, things will go one of two ways, but either way, it’s going to start mattering where you do residency, so start doing heavy research on what programs you might be interested in so you know which ones to avoid;

1) supply hits a critical mass in 10 years or so, assuming the ACEP piece about supply overtaking demand doesn’t self correct from current students avoiding EM because of the spectre of being unemployed. It’ll start mattering where you do residency. Avoid residencies sponsored by HCA (you have to look closely sometimes, they try to hide their affiliation), 1/2 of the residencies in the Southeast (HCA), residencies sponsored by any corporate group (CMGs, and even some university programs), and anywhere with an EM fellowship for midlevels. A good rule of thumb from interviewing at programs across the spectrum last year is basically if it was founded after 2010, it’s bad news. There are even programs that might be affiliated with otherwise famous institutions that are trash-tier, because they rest on the laurels of the sponsoring institution that might otherwise be considered elite.

2) Same scenario as above, but make a point of going to the ****-tier programs because they purposely train their grads to be unhireable by decent hospitals through an insane focus on billing during training, and therefore you’re guaranteed employment with them after graduation at a ****ty rate. While anyone who trained at a reputable program will be priced out of the market in a world where quantity > quality.

I disagree. Why do it matter where you did residency if EM becomes very corporatized? These recruiters don't know what a good vs bad program is. They are completely clueless. I do agree with you that these ****ty programs need to close but as long as these graduates are board certified by ABEM, they'll be grouped the same as everyone else.

The more likely scenarios is that FM/IM doctors will no longer be hired in the EDs. Most rural ERs right now are staffed by FM-trained doctors.

 

[Dr Mantis Toboggan]

I disagree. Why do it matter where you did residency if EM becomes very corporatized? These recruiters don't know what a good vs bad program is. They are completely clueless. I do agree with you that these ****ty programs need to close but as long as these graduates are board certified by ABEM, they'll be grouped the same as everyone else.

The more likely scenarios is that FM/IM doctors will no longer be hired in the EDs. Most rural ERs right now are staffed by FM-trained doctors.

They’ll put midlevels in the small rural places before playing top dollar for ABEM docs.

 

[cyanide12345678]

With the job market the way it is, things will go one of two ways, but either way, it’s going to start mattering where you do residency, so start doing heavy research on what programs you might be interested in so you know which ones to avoid;

1) supply hits a critical mass in 10 years or so, assuming the ACEP piece about supply overtaking demand doesn’t self correct from current students avoiding EM because of the spectre of being unemployed. It’ll start mattering where you do residency. Avoid residencies sponsored by HCA (you have to look closely sometimes, they try to hide their affiliation), 1/2 of the residencies in the Southeast (HCA), residencies sponsored by any corporate group (CMGs, and even some university programs), and anywhere with an EM fellowship for midlevels. A good rule of thumb from interviewing at programs across the spectrum last year is basically if it was founded after 2010, it’s bad news. There are even programs that might be affiliated with otherwise famous institutions that are trash-tier, because they rest on the laurels of the sponsoring institution that might otherwise be considered elite.

2) Same scenario as above, but make a point of going to the ****-tier programs because they purposely train their grads to be unhireable by decent hospitals through an insane focus on billing during training, and therefore you’re guaranteed employment with them after graduation at a ****ty rate. While anyone who trained at a reputable program will be priced out of the market in a world where quantity > quality.

Doesn't matter one bit where you did residency for community medicine. As long as you are board certified, that's all that matters.

For academics, the brand has value, otherwise not so much.

 

[Kryptocoin]

They’ll put midlevels in the small rural places before playing top dollar for ABEM docs.

Already happening. I got replaced by a midlevel at one of my rural gigs.

 

[Dr Mantis Toboggan]

Already happening. I got replaced by a midlevel at one of my rural gigs.

Sucks man. Sorry.

 

[Apollyon]

Already happening. I got replaced by a midlevel at one of my rural gigs.

Dude, bummer. But, you know what? You get what you pay for. They'll get theirs.

 

[Kryptocoin]

Dude, bummer. But, you know what? You get what you pay for. They'll get theirs.

Yeah, definitely a bummer. Paid $275/hr to staff a rural ER, saw 10/day. Worked 24h shifts. No one shows up after midnight. Sounded like a sweet gig and it was. After 4 months, replaced my shifts with an NP making $60/hr.

 

[Kryptocoin]

I still keep in touch with the nurses and they told me a story. Patient comes in acute respiratory distress. Was satting 80s on NRB. NP tried to intubate SEVEN times and still couldn't tube the patient. They had to wake up the local FM doc that does prn shifts in the ED. He came in and tube the patient on first try. That NP still works there.

 

[Brigade4Radiant]

My bro was going to do EM like me but he wants to live in LA above all else so he is going to do FM or psychiatry .

I feel so foolish that in the past I thought I was better than those specialties

 

[Brigade4Radiant]

Yeah, definitely a bummer. Paid $275/hr to staff a rural ER, saw 10/day. Worked 24h shifts. No one shows up after midnight. Sounded like a sweet gig and it was. After 4 months, replaced my shifts with an NP making $60/hr.

The C suite is now looking at if they truly need an ABEM doc since a lot of these places the acuity is low then if someone needs an ABEM doc they figure it would be cheaper to eat the lawsuit which they can argue down or even win if it’s not gross negligence especially in these rural states

 

[Dr Mantis Toboggan]

My bro was going to do EM like me but he wants to live in LA above all else so he is going to do FM or psychiatry .

I feel so foolish that in the past I thought I was better than those specialties

We all thought we were better off than those specialties. We all did. At least now through the forum we can open the eyes of the next generation. Caveat emptor, future EM residents, caveat emptor.

 

[jw3600]

With the job market the way it is, things will go one of two ways, but either way, it’s going to start mattering where you do residency, so start doing heavy research on what programs you might be interested in so you know which ones to avoid;

1) supply hits a critical mass in 10 years or so, assuming the ACEP piece about supply overtaking demand doesn’t self correct from current students avoiding EM because of the spectre of being unemployed. It’ll start mattering where you do residency. Avoid residencies sponsored by HCA (you have to look closely sometimes, they try to hide their affiliation), 1/2 of the residencies in the Southeast (HCA), residencies sponsored by any corporate group (CMGs, and even some university programs), and anywhere with an EM fellowship for midlevels. A good rule of thumb from interviewing at programs across the spectrum last year is basically if it was founded after 2010, it’s bad news. There are even programs that might be affiliated with otherwise famous institutions that are trash-tier, because they rest on the laurels of the sponsoring institution that might otherwise be considered elite.

2) Same scenario as above, but make a point of going to the ****-tier programs because they purposely train their grads to be unhireable by decent hospitals through an insane focus on billing during training, and therefore you’re guaranteed employment with them after graduation at a ****ty rate. While anyone who trained at a reputable program will be priced out of the market in a world where quantity > quality.

You missed the boat. **** bro you missed the ocean.

 

[jw3600]

I still keep in touch with the nurses and they told me a story. Patient comes in acute respiratory distress. Was satting 80s on NRB. NP tried to intubate SEVEN times and still couldn't tube the patient. They had to wake up the local FM doc that does prn shifts in the ED. He came in and tube the patient on first try. That NP still works there.

Was there a lawsuit? Doesn’t matter then.