Interviews of the Presidents of EMRA and RSA…thoughts?

[Little drop of rain]

Residency Organization Leaders Weigh in on the State of... : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

---

Members don't see this ad.

 

[sylvanthus]

Not gonna read opinions on the field of EM from those that havent worked a single day as an attending.

 

[EctopicFetus]

Not gonna read opinions on the field of EM from those that havent worked a single day as an attending.

Agreed. I saw this posted elsewhere and i cant help but think WTF do these people know. Residents in this day and age are coddled, have little idea of real life EM practice. The EMRA one is an ACEP boot slurper I am sure. Move along. Probably gonna become a USACS admin fellow so they can further abuse their fellow EM docs. Piss off kids.

 

[TooMuchResearch]

Residency Organization Leaders Weigh in on the State of... : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

My thoughts are that they had to fill more pages to sell ads. I didn't renew this free publication because I find little value in it

 

[JacobMcCandles]

Didn’t read but graduating residents over the last few years, as a whole, have been much weaker than their counterparts the previous years before that.

 

[The Knife & Gun Club]

Didn’t read but graduating residents over the last few years, as a whole, have been much weaker than their counterparts the previous years before that.

In what sense? Slower? Miss things? Rely more heavily on consultants? I know people that trained during covid had a noticeable change in their training environment for like 18 months which could be at least partially to blame. For example I was an intern when covid hit and so for a big chunk of residency our hospitals policy was no DL allowed, only video intubations so my direct skills are way weaker than someone who trained pre pandemic.

I do think some of the older docs tend to confuse my generation of docs desire for more work life balance with being “weaker” and that’s not necessarily accurate. We trained during a time when EM got dragged through the mud by the powers at be so feel less loyalty to the hospital system/leadership and so are often less willing to “take one for the team” because we saw no one was willing to return the favor when the chips were down and the field was/is still on fire.

 

[JacobMcCandles]

In what sense? Slower? Miss things? Rely more heavily on consultants? I know people that trained during covid had a noticeable change in their training environment for like 18 months which could be at least partially to blame. For example I was an intern when covid hit and so for a big chunk of residency our hospitals policy was no DL allowed, only video intubations so my direct skills are way weaker than someone who trained pre pandemic.

The biggest is a lack of confidence which affects basically everything. We’ve had several who didn’t feel comfortable at a single coverage place that can get busy.

A noticeable change in your training environment for 18 months is huge when you have a 36 month training window.

 

[BoardingDoc]

My thoughts are that they had to fill more pages to sell ads. I didn't renew this free publication because I find little value in it

You can not renew? They've been sending this thing to my house since I graduated residency. No idea how I started getting it, nor how to make it stop. I suppose it isn't too hard to take it and drop it in the recycling bin each time it shows up, but it certainly is a waste of paper.

 

[TooMuchResearch]

You can not renew? They've been sending this thing to my house since I graduated residency. No idea how I started getting it, nor how to make it stop. I suppose it isn't too hard to take it and drop it in the recycling bin each time it shows up, but it certainly is a waste of paper.

Yeah they make me renew it annually, which I stopped doing.

 

[TooMuchResearch]

In what sense? Slower? Miss things? Rely more heavily on consultants? I know people that trained during covid had a noticeable change in their training environment for like 18 months which could be at least partially to blame. For example I was an intern when covid hit and so for a big chunk of residency our hospitals policy was no DL allowed, only video intubations so my direct skills are way weaker than someone who trained pre pandemic.

I do think some of the older docs tend to confuse my generation of docs desire for more work life balance with being “weaker” and that’s not necessarily accurate. We trained during a time when EM got dragged through the mud by the powers at be so feel less loyalty to the hospital system/leadership and so are often less willing to “take one for the team” because we saw no one was willing to return the favor when the chips were down and the field was/is still on fire.

We did 100% of our residency intubations, with the exception of a couple of times when we ran out of clean CMAC blades, on video but could DL with the video scope if wanted. There is no reason to do old school DL.

 

[EctopicFetus]

I think the new grads are slower, more entitled, whiny, refuse to actually order tests that make sense and generally shotgun workups in ways that is purely nonsensical. Ask one of them "why did you order X test". The common answer is well i just always do that.

A solid example is patient with lower belly pain (Imagine colitis vs diverticulitis) and patient gets a lipase. Like come on.. just stupid and nonsensical.

We were just talking about our hiring needs and one of our main guys says "10 years ago anyone who finished an EM residency was good but now we need to vet them hard cause the quality has dropped". Frankly it is not surprising. Slots have increased, sites that train have expanded including facilities that have no business training residents.

So this has dragged the avg down. the HCA grads are particularly idiotic. They have been trained in an environment where they dont think, are beaten down by real idiot RN admins and NPs.

Thats a hard stop, show me that on a CV and Ill show you someone i wouldnt consider hiring.

 

[RustedFox]

I think the new grads are slower, more entitled, whiny, refuse to actually order tests that make sense and generally shotgun workups in ways that is purely nonsensical. Ask one of them "why did you order X test". The common answer is well i just always do that.

A solid example is patient with lower belly pain (Imagine colitis vs diverticulitis) and patient gets a lipase. Like come on.. just stupid and nonsensical.

We were just talking about our hiring needs and one of our main guys says "10 years ago anyone who finished an EM residency was good but now we need to vet them hard cause the quality has dropped". Frankly it is not surprising. Slots have increased, sites that train have expanded including facilities that have no business training residents.

So this has dragged the avg down. the HCA grads are particularly idiotic. They have been trained in an environment where they dont think, are beaten down by real idiot RN admins and NPs.

Thats a hard stop, show me that on a CV and Ill show you someone i wouldnt consider hiring.

Bro. I would get that lipase too. I would also expect it to be normal, but I would order it.

I do this because I live in Florida and sometimes, the pancreas is in the RLQ in these ancients.

 

[bravotwozero]

Yeah I second that. Localization of pain and history is a frequent problem area in my neck of the woods too, be it old people or homeless meth heads and schizophrenics.

 

[Brigade4Radiant]

I really don’t see a problem of ordering a lipase especially if you’re ordering a CBC and a CMP.

I’ve had bad pancreatitis and complain of right lower quadrant pain.

 

[GonnaBeADoc2222]

I think the new grads are slower, more entitled, whiny, refuse to actually order tests that make sense and generally shotgun workups in ways that is purely nonsensical. Ask one of them "why did you order X test". The common answer is well i just always do that.

A solid example is patient with lower belly pain (Imagine colitis vs diverticulitis) and patient gets a lipase. Like come on.. just stupid and nonsensical.

We were just talking about our hiring needs and one of our main guys says "10 years ago anyone who finished an EM residency was good but now we need to vet them hard cause the quality has dropped". Frankly it is not surprising. Slots have increased, sites that train have expanded including facilities that have no business training residents.

So this has dragged the avg down. the HCA grads are particularly idiotic. They have been trained in an environment where they dont think, are beaten down by real idiot RN admins and NPs.

Thats a hard stop, show me that on a CV and Ill show you someone i wouldnt consider hiring.

Back in myyyy dayyyyyyyyyyy

Zero issue with that lipase. Like thats the thing to hone in on??

 

[RustedFox]

SDN got a mention in the article.

One might think that medical students do not consider issues like private-equity-backed-CMGs, physician burnout, or scope creep. But I know they do. I mentor several medical students now, and they are concerned about these issues. They are on social media sites like Reddit and Student Doctor Network and see that emergency medicine is on fire. They also know that we have a lot of unfilled positions in the match. So, when medical students choose between two specialties, many will apply to the other specialty and figure they can always SOAP into emergency medicine if they do not match.

"The see that EM is on fire".

Welp. To any of those kids reading this: "Don't do EM"

 

[EctopicFetus]

Back in myyyy dayyyyyyyyyyy

Zero issue with that lipase. Like thats the thing to hone in on??

The list is long thats just an easy example. I mean frankly why bother having an EM doc when every complaint gets every test?

We have one young doc whose CT utilization is 3+ standard deviation above the mean and 9% higher than the next highest doc (out of 30 or so). Its not super hard being an EM doc when you order all the tests all the time and CT every complaint. HA for chronic migraine, 5th visit this month and had a negative MRI /MRV/MRA within the last week. Welp repeat CT. yipeee.

To each their own.. sometimes it makes sense to get the lipase, sometimes you have to hit the "on" button on your brain and hopefully go back to your training (at a non HCA site) and be an actual doctor.

 

[RustedFox]

The list is long thats just an easy example. I mean frankly why bother having an EM doc when every complaint gets every test?

We have one young doc whose CT utilization is 3+ standard deviation above the mean and 9% higher than the next highest doc (out of 30 or so). Its not super hard being an EM doc when you order all the tests all the time and CT every complaint. HA for chronic migraine, 5th visit this month and had a negative MRI /MRV/MRA within the last week. Welp repeat CT. yipeee.

To each their own.. sometimes it makes sense to get the lipase, sometimes you have to hit the "on" button on your brain and hopefully go back to your training (at a non HCA site) and be an actual doctor.

Now if you had written this, instead of "lipase", I would have thumbed you up.
This is worlds apart.

 

[Jabbed]

Didn’t read but graduating residents over the last few years, as a whole, have been much weaker than their counterparts the previous years before that.

I think the new grads are slower, more entitled, whiny, refuse to actually order tests that make sense and generally shotgun workups in ways that is purely nonsensical. Ask one of them "why did you order X test". The common answer is well i just always do that.

A solid example is patient with lower belly pain (Imagine colitis vs diverticulitis) and patient gets a lipase. Like come on.. just stupid and nonsensical.

We were just talking about our hiring needs and one of our main guys says "10 years ago anyone who finished an EM residency was good but now we need to vet them hard cause the quality has dropped". Frankly it is not surprising. Slots have increased, sites that train have expanded including facilities that have no business training residents.

So this has dragged the avg down. the HCA grads are particularly idiotic. They have been trained in an environment where they dont think, are beaten down by real idiot RN admins and NPs.

Thats a hard stop, show me that on a CV and Ill show you someone i wouldnt consider hiring.

Okay boomer.

Up until this year most EM graduates were high caliber applicants 3-4 years ago. Granted, the proliferation of residency positions, particularly HCA, has bred lower quality physicians and diluted stock.

With regards to your examples: CT utilization is generally higher in younger grads, but heavy utilizers are heavy utilizers regardless of when they were born. At my site the highest CT utilization is by our 60-year-old medical director.

And over-ordering lipase? Seriously? Do you practice in the NHS??

 

[EctopicFetus]

Okay boomer.

Up until this year most EM graduates were high caliber applicants 3-4 years ago. Granted, the proliferation of residency positions, particularly HCA, has bred lower quality physicians and diluted stock.

With regards to your examples: CT utilization is generally higher in younger grads, but heavy utilizers are heavy utilizers regardless of when they were born. At my site the highest CT utilization is by our 60-year-old medical director.

And over-ordering lipase? Seriously? Do you practice in the NHS??

Ok whipper snapper. LOL. based on your answer are you out 3 or 4 years? Did someone’s feelings get hurt? the proliferation of residency sports started about 5 years ago. That let in a bunch of low level mouth breathers into the specialty. My guess the old guy who CTs everything is burnt out and refuses to think. The young doc doesnt know any better. Ive seen both sides. The youngsters pranced around so proud to be called “healthcare heroes” it was cute. I said then it was idiotic.. it still holds true. People on FB and SoMe bragging how the specialists finally respected us too naive to see it would be short lived and was pure lip service. It’s cute young fella.

Listen re the lipase issue its a test.. its not even all about cost, its also about one more test taht might not come back in a decent amount of time, its a test thats not needed that delays dispos. So sure if you work at the VA and 25 in the WR is ok as the lowly vets dont get pt satisfaction Surveys. The stock of EM docs has been softening for some time. The graph is from EMRA. Almost 1k more positions in the last decade.. but yeah.. 3-4 years.. lolz..

 

[The Knife & Gun Club]

The biggest is a lack of confidence which affects basically everything. We’ve had several who didn’t feel comfortable at a single coverage place that can get busy.

A noticeable change in your training environment for 18 months is huge when you have a 36 month training window.

Yea having the hospital in “disaster mode” for half of training I think had a really measurable and significant impact on people coming out in recent years.

I wonder when the shift occurred to not wanting to do single coverage right out of the gate? Where I trained most of the faculty advised against doing single coverage when starting out. About half our class ended up doing it anyway and they’re all fine so I imagine not an issue with training as much as maybe an issue with the confidence of the residents and of the academic EM docs training the current generation.

Personally since I’m in fellowship I can’t do single coverage for my moonlighting shifts but kinda wish I could so I could get used to the real world a bit.

 

[JacobMcCandles]

Yea having the hospital in “disaster mode” for half of training I think had a really measurable and significant impact on people coming out in recent years.

I wonder when the shift occurred to not wanting to do single coverage right out of the gate? Where I trained most of the faculty advised against doing single coverage when starting out. About half our class ended up doing it anyway and they’re all fine so I imagine not an issue with training as much as maybe an issue with the confidence of the residents and of the academic EM docs training the current generation.

Personally since I’m in fellowship I can’t do single coverage for my moonlighting shifts but kinda wish I could so I could get used to the real world a bit.

The issue is that there’s a lot of single coverage EDs out there. If you don’t feel comfortable working them then that hampers your job search as well as recruiting efforts if you have some single coverage facilities. The strongest new attendings we’ve had have almost all been moonlighters and many at single coverage places.