New EM residencies in the works

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Speaking as a PA-boy, Reading is well-known as one of THE biggest, nastiest hospitals in all of PA. Whoever goes there is going to get great training.
 
RustedFox said:
Speaking as a PA-boy, Reading is well-known as one of THE biggest, nastiest hospitals in all of PA. Whoever goes there is going to get great training.
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haha so funny that this is very common em mentality...a love for big nasy hospitals
 
docvino said:
haha so funny that this is very common em mentality...a love for big nasy hospitals
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I hated them. I put my time in at "Nasty General". I love my moderate-acuity shop right now.

I think the key is (for me)... recognizing that I'm in a spot where I "see what I like to see".

That's.... really important. Overall.
 
RustedFox said:
I hated them. I put my time in at "Nasty General". I love my moderate-acuity shop right now.

I think the key is (for me)... recognizing that I'm in a spot where I "see what I like to see".

That's.... really important. Overall.
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interesting perspective. never thought about that.

eeek!!! excited to start my career as an em physician...aka an er doc 🙂
 
Good luck.

I should be more clear about what I mean: I see some high-acuity, but its all medically-complicated old folks. A-fib in the setting of CHF and hypoxemia, lots of lung disease, drug toxicities, etc.

The stuff that I'm D.O.N.E. with is the knife-and-gun club/intoxicated youth nonsense.

No, thanks.
 
RustedFox said:
Speaking as a PA-boy, Reading is well-known as one of THE biggest, nastiest hospitals in all of PA. Whoever goes there is going to get great training.
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You ain't kidding...
"The Department of Emergency Medicine has the busiest ER by volume in Pennsylvania and is one of the 50 busiest in the country. The 60 emergency medicine department physicians are employed by the system; there are 108 emergency medicine department bays and 295 nurses. The average daily volume is approximately 400, and there are 38 full- and part-time advanced practitioners.
 
Anyone else think we shouldn't be opening a ton of er residencies? I feel like we should keep a good supply and demand balance. Thoughts?
 
thorg12 said:
Anyone else think we shouldn't be opening a ton of er residencies? I feel like we should keep a good supply and demand balance. Thoughts?
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Are there not still plenty of EDs that are not staffed by EM physicians? Is there ANY evidence that the supply of EM physicians is greater than the demand currently or projected for the future? Part of the cause of the looming physician shortage and proliferation of mid-levels is the manipulation of the supply of physicians. Isn't that history we should be learning from?
 
medicsb said:
Are there not still plenty of EDs that are not staffed by EM physicians? Is there ANY evidence that the supply of EM physicians is greater than the demand currently or projected for the future? Part of the cause of the looming physician shortage and proliferation of mid-levels is the manipulation of the supply of physicians. Isn't that history we should be learning from?
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I think looking at radiology an pathology a little bit of caution for the future might not be a bad idea.
 
Agreed. If there was any reason that we shouldn't be opening more residency positions then I'd like to hear it. When EM is one of the more highly contested residencies with WAY more applicants than slots and the specialty is filling pretty much all of it's spots in at least the last 2 years (I don't consider 3 slots this year, 2 of which reportedly weren't even offered in the match "left overs") I find it hard to understand why we shouldn't be trying to match supply if the demand is definitely there.

As for Radiology and Pathology.... with the ability to view imaging electronically now it's not hard to see why some radiology spots are being (or are being threatened to be) outsourced. I think you'd be hard pressed to say EM will ever be outsourced to cheaper competition overseas. As for Path and any other specialty really... popularity and demand comes and goes... but to not prepare for the current and near future by saying "demand in the distant future probably won't support the need we have now" without ANY indication of that really doesn't seem to make sense to me.

medicsb said:
Are there not still plenty of EDs that are not staffed by EM physicians? Is there ANY evidence that the supply of EM physicians is greater than the demand currently or projected for the future? Part of the cause of the looming physician shortage and proliferation of mid-levels is the manipulation of the supply of physicians. Isn't that history we should be learning from?
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sbreland said:
Agreed. If there was any reason that we shouldn't be opening more residency positions then I'd like to hear it. When EM is one of the more highly contested residencies with WAY more applicants than slots and the specialty is filling pretty much all of it's spots in at least the last 2 years (I don't consider 3 slots this year, 2 of which reportedly weren't even offered in the match "left overs") I find it hard to understand why we shouldn't be trying to match supply if the demand is definitely there.

As for Radiology and Pathology.... with the ability to view imaging electronically now it's not hard to see why some radiology spots are being (or are being threatened to be) outsourced. I think you'd be hard pressed to say EM will ever be outsourced to cheaper competition overseas. As for Path and any other specialty really... popularity and demand comes and goes... but to not prepare for the current and near future by saying "demand in the distant future probably won't support the need we have now" without ANY indication of that really doesn't seem to make sense to me.
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Reasons:
1. Mid-levels
2. Mid-levels
3. Mid-levels

You think I'm joking but I can see EM eventually going the route of a smaller number of EM docs managing a bunch of mid-levels in the ER, much like how PP Anesthesia functions.
 
Acad Emerg Med. 2009 Oct;16(10):1014-8.
Supply and demand of board-certified emergency physicians by U.S. state, 2005.
Sullivan AF, Ginde AA, Espinola JA, Camargo CA Jr.


Department of Emergency Medicine, Massachusetts General Hospital, Boston, MA, USA.
Abstract
OBJECTIVES:

The objective was to estimate the emergency medicine (EM) board-certified emergency physician (EP) workforce supply and demand by U.S. state.
METHODS:

The 2005 National Emergency Department Inventories-USA provided annual visit volumes for U.S. emergency departments (EDs). We estimated full-time equivalent (FTE) EP demand at each ED by dividing the actual number of visits by the estimated average EP visit volume (3,548 visits/year) and then summing FTEs by state. Our model assumed that at least one EP should be present 24/7 in each ED. The number of EM board-certified EPs per state was provided by the American Board of Medical Specialties (American Board of Emergency Medicine, American Board of Pediatrics) and the American Osteopathic Board of Emergency Medicine. We used U.S. Census Bureau civilian population estimates to calculate EP population density by state.
RESULTS:

The supply of EM board-certified EPs was 58% of required FTEs to staff all EDs nationally and ranged from 10% in South Dakota to 104% in Hawai'i (i.e., there were more EPs than the estimated need). Texas and Florida had the largest absolute shortages of EM board-certified EPs (2,069 and 1,146, respectively). The number of EM board-certified EPs per 100,000 U.S. civilian population ranged from 3.6 in South Dakota to 13.8 in Washington, DC. States with a higher population density of EM board-certified EPs had higher percent high school graduates and a lower percent rural population and whites.
CONCLUSIONS:

The supply and demand of EM board-certified EPs varies by state. Only one state had an adequate supply of EM board-certified EPs to fully staff its EDs.


----

Acad Emerg Med. 1997 Jul;4(7):725-30.
Workforce projections for emergency medicine: how many emergency physicians does the United States need?
Holliman CJ, Wuerz RC, Chapman DM, Hirshberg AJ.
Source

Pennsylvania State University, Milton S. Hershey Medical Center, Emergency Department, Hershey 17033-0850, USA.
Abstract
OBJECTIVE:

To mathematically model the supply of and demand for emergency physicians (EPs) under different workforce conditions.
METHODS:

A computer spreadsheet model was used to project annual EP workforce supply and demand through the year 2035. The mathematical equations used were: supply = number of EPs at the beginning of the year plus annual residency graduates minus annual attrition; demand = 5 full-time equivalent positions/ED x the number of hospital EDs. The demand was empirically varied to account for ED census variation, administrative and teaching responsibilities, and the availability of physician extenders. A variety of possible scenarios were tested. These projections make the assumption that emergency medicine (EM) residency graduates will preferentially fill clinical positions currently filled by EPs without EM board certification.
RESULTS:

Under most of the scenarios tested, there will be a large deficit of EM board-certified EPs well into the next century. Even in scenarios involving a decreasing "demand" for EPs (e.g., in the setting of hospital closures or the training of physician extenders), a significant deficit will remain for at least several decades.
CONCLUSIONS:

The number of EM residency positions should not be decreased during any restructuring of the U.S. health care system. EM is likely to remain a specialty in which the supply of board-certified EPs will not meet the demand, even at present levels of EM residency output, for the next several decades.
 
sbreland said:
Agreed. If there was any reason that we shouldn't be opening more residency positions then I'd like to hear it. When EM is one of the more highly contested residencies with WAY more applicants than slots and the specialty is filling pretty much all of it's spots in at least the last 2 years (I don't consider 3 slots this year, 2 of which reportedly weren't even offered in the match "left overs") I find it hard to understand why we shouldn't be trying to match supply if the demand is definitely there.
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You have the wrong supply and demand here. We need to match the supply of EM physicians to the demand for their services. Not the number of residency spots to the demand from medical students.
 
DrYoda said:
You have the wrong supply and demand here. We need to match the supply of EM physicians to the demand for their services. Not the number of residency spots to the demand from medical students.
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The point of my post is that it is well established (as cited by medicsb above) that the supply is NOT meeting the demand (for EM physician services). You can't just "create" more physicians unless you create more spots. If there were open spots every year like in Family med then I'd say "sure, no need to increase the number of residency positions" but since that does not happen then we need more spots. It would be like a farmer saying "we need more eggs to fill our orders" but not even thinking about that in order to increase the number of eggs he produces, he'll need to increase the number of chickens he has. My supply/demand aren't wrong, it's just addressing it at one step higher than you are talking about... the source. If you know of any other way to create more board certified EPs without creating more residency slots then I'm sure we'd (and the government) love to hear about it! 😀
 
sbreland said:
The point of my post is that it is well established (as cited by medicsb above) that the supply is NOT meeting the demand (for EM physician services). You can't just "create" more physicians unless you create more spots. If there were open spots every year like in Family med then I'd say "sure, no need to increase the number of residency positions" but since that does not happen then we need more spots. It would be like a farmer saying "we need more eggs to fill our orders" but not even thinking about that in order to increase the number of eggs he produces, he'll need to increase the number of chickens he has. My supply/demand aren't wrong, it's just addressing it at one step higher than you are talking about... the source. If you know of any other way to create more board certified EPs without creating more residency slots then I'm sure we'd (and the government) love to hear about it! 😀
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Since we're on the topic now, job market modelling is never accurate since no one knows what events and advances the future holds which will alter demand (in the case of healthcare it's probably changes in productivity that will ruin our models). We also need to consider it will be hard to close programs or reduce spots once they are opened. We wouldn't want to create an oversupply by aggressively going after a shortage (or worse, a distant future projected one). I was never disputing that there's a physician shortage, just that we really have no really good way to know if we should or shouldn't open residencies, and it would thus be best to be cautious.
 
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DreamingTheLive said:
Reasons:
1. Mid-levels
2. Mid-levels
3. Mid-levels

You think I'm joking but I can see EM eventually going the route of a smaller number of EM docs managing a bunch of mid-levels in the ER, much like how PP Anesthesia functions.
Click to expand...

This would happen if EPs were unable to staff EDs appropriately, you know, because there are not enough EPs (currently the case) . Or, it's because some EPs don't actually value medicine or themselves and are willing to sell out the profession to a less educated person in order to make money (which is what anesthesia did). It is not a given that mid-levels will take over anything more than they have unless medicine allows it.
 
Not to be all negative up in here... But it seems we have to worry about hospitals and corporate groups that are increasingly employing physicians selling out our profession for us as well (and then we won't even make any money off it🙁).
 
medicsb said:
This would happen if EPs were unable to staff EDs appropriately, you know, because there are not enough EPs (currently the case) . Or, it's because some EPs don't actually value medicine or themselves and are willing to sell out the profession to a less educated person in order to make money (which is what anesthesia did). It is not a given that mid-levels will take over anything more than they have unless medicine allows it.
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Lol, you're betting against individuals selling-out? And you reall think that its entirely up to EM physicians?

M1?
 
DreamingTheLive said:
Lol, you're betting against individuals selling-out? And you reall think that its entirely up to EM physicians?

M1?
Click to expand...

I do like to think there are more with some integrity who won't just roll over when something gets tough (even if personal experience tells me otherwise). And where did I say it is entirely up to EPs? The future is certainly determined by wide range of factors of which EM physicians (or physicians in general) and just one, but I reject any inclination towards apathy or cynicism as if physicians yield no power.

M what?
 
Two things I think are important for Em docs, I'm only a resident that recently went through the job hunt.
1. I disagree with contracts management groups. That's a different subject
2. I'll have to find the review opinion piece in Em news or something. That says we shouldn't be making a surplus of us
I'm not how I feel about it yet but it was pretty nice to get a lot of job interviews and pick where I wanted to work. I hope it's like that for everyone else.
 
medicsb said:
I'm well aware of what he or she meant. My year is largely irrelevant as is theirs. Argumentum ad hominem.
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If you were aware, and now claim "argumentum ad hominem", then your style is not readily perceptible. It is not insulting the person to claim insufficient knowledge.

However, we've seen it time and again - students and residents that seem to forget that everyone above - bar none - has gone to college, med school, and through residency, and we all have been there already. When someone suggests, or states outright, that you don't know about which you are talking, that is not equivalent to "well, you're ugly!".
 
Apollyon said:
If you were aware, and now claim "argumentum ad hominem", then your style is not readily perceptible. It is not insulting the person to claim insufficient knowledge.

However, we've seen it time and again - students and residents that seem to forget that everyone above - bar none - has gone to college, med school, and through residency, and we all have been there already. When someone suggests, or states outright, that you don't know about which you are talking, that is not equivalent to "well, you're ugly!".
Click to expand...

When it comes from another medical student, it is. I am open to different viewpoints and am willing to change my point of view if there is a convincing argument. But, resorting to "you are inexperienced and don't know what you're talking about" does not convince anyone of anything. It's a cop-out. I mean I have 10 years in healthcare, should I try and knock someone down because I've been around longer?

Anyhow, no one has made a convincing argument that there should not be more residencies, which isn't really what this thread was about, but since we're on the tangent, I'd like to hear some good arguments, if there is any.
 
i know this is naive; but, i will be a DO class of 2017 and currently want to enter EM. this is based on my limited experience in a number of clinical settings. considering the negatives and positives, you all make it sound like the best field. how do you recommend becoming a competitive EM residency applicant from day one of med school, including 1st-4th year. do you think the more competitive spots will be more DO-friendly by 2017? Do you think this merger fiasco will have an effect? Also, I will be in my very early 30s at start of residency..what are your thoughts of EM/IM to have more versatile training, because I may not be so into EM when I am 60?
 
medicsb said:
I'm well aware of what he or she meant. My year is largely irrelevant as is theirs. Argumentum ad hominem.
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Sigh. You sound like you're looking for an argument, not a discussion. Cute with the Latin though.
 
medicsb said:
When it comes from another medical student, it is. I am open to different viewpoints and am willing to change my point of view if there is a convincing argument. But, resorting to "you are inexperienced and don't know what you're talking about" does not convince anyone of anything. It's a cop-out. I mean I have 10 years in healthcare, should I try and knock someone down because I've been around longer?

Anyhow, no one has made a convincing argument that there should not be more residencies, which isn't really what this thread was about, but since we're on the tangent, I'd like to hear some good arguments, if there is any.
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Why don't you do this make a chart that shows how many new EM graduates there are. Then make a chart of the shortage. Then add projected yearly growth and subtract the burnout and retirement projected each year. So lets say an EM doc has a thirty year career. A retirement rate of 3 percent and lets throw in a burnout of 2 percent. This will give you a rough idea of how long it will take for current supply to meet demand. That is when you can tell at which point you will have saturation. This way you can prove your argument to yourself.

Oh and based on your article you would use the 58 percent from 2005 not now. So the number of EM docs then.

The reason they asked your year was because your arguments have more idealism than reality in them in regards to what superpowers we have after medical school.
 
Tele-radiology has been around for awhile and isn't booming like they thought. The reason the new grads even in IR can't find jobs is that enough people aren't retiring. You have saturation. More new grads than openings so people are doing multiple fellowships.

Coping out of an argument is when you ignore events that are happening around you and say this will never happen to us so give me a different argument. It can happen to your speciality. Better to prevent it from happening versus waiting for it to happen and then going crap!

You know what happened in the 70s right?
 
I also responded whole sitting on the toilet because I didn't want to waste my time. I know you're going to continue to argue this. You're looking to prove your point right, not really to change yours by listening to others. Time for me to get off the toilet.
 
SeekerOfTheTree said:
You know what happened in the 70s right?
Click to expand...

The bar code was introduced
18 year olds got the right to vote in federal elections
The world trade center was completed
Cigarette ads were banned from TV
China joined the UN
DB Cooper skyjacked Northwest Airlines
Charles Manson was convicted
President Nixon visted China
The last Apollo mission to the moon
Vietnam war ended
Nixon resigned
Stephen Hawking proposed a new black hole theory
Baryshnikov defected from the Soviet Union
Hank Aaron beat Babe Ruth's homerun record
Catalytic converters were introduced on cars
Lyme disease was discovered
Jimmy Hoffa disappeared
Apple computer was launched
Mao Tse-tung died
Red dye #2 was banned
The first woman episcopal priest was ordained
Jonestown massacre
Garfield the cat was syndicated
Larry Flynt was shot and paralyzed
Iranian students stormed the US embassy
Three mile island partial meltdown occurred
Mother Teresa won a nobel prize
ESPN started broadcasting

I'm sure there were other things as well... it was a pretty long decade.
 
SeekerOfTheTree said:
Tele-radiology has been around for awhile and isn't booming like they thought. The reason the new grads even in IR can't find jobs is that enough people aren't retiring. You have saturation. More new grads than openings so people are doing multiple fellowships.

Coping out of an argument is when you ignore events that are happening around you and say this will never happen to us so give me a different argument. It can happen to your speciality. Better to prevent it from happening versus waiting for it to happen and then going crap!

You know what happened in the 70s right?
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Telerads isn't booming bit it has absolutely changed the field of radiology.
 
JShephard said:
Telerads isn't booming bit it has absolutely changed the field of radiology.
Click to expand...

What percentage of radiologist don't have jobs because of it. The examples of use I have seen are to have rural reads go to academic centers or satellite centers go to hubs. Also have seen night coverage done by nighthawk service in Australia. You could find an example that is an exception just like their are examples of ERs run completely by mid levels. But it is not significant enough to impact demand or job outlook terribly because these are exceptions.

The point is supply and demand. If you increase supply too quickly demand will decrease.
 
Doctor Bob said:
The bar code was introduced
18 year olds got the right to vote in federal elections
The world trade center was completed
Cigarette ads were banned from TV
China joined the UN
DB Cooper skyjacked Northwest Airlines
Charles Manson was convicted
President Nixon visted China
The last Apollo mission to the moon
Vietnam war ended
Nixon resigned
Stephen Hawking proposed a new black hole theory
Baryshnikov defected from the Soviet Union
Hank Aaron beat Babe Ruth's homerun record
Catalytic converters were introduced on cars
Lyme disease was discovered
Jimmy Hoffa disappeared
Apple computer was launched
Mao Tse-tung died
Red dye #2 was banned
The first woman episcopal priest was ordained
Jonestown massacre
Garfield the cat was syndicated
Larry Flynt was shot and paralyzed
Iranian students stormed the US embassy
Three mile island partial meltdown occurred
Mother Teresa won a nobel prize
ESPN started broadcasting

I'm sure there were other things as well... it was a pretty long decade.
Click to expand...

Lol, most important on this list of course. Both for better, and lately for worse as ESPN is "ESPNing" itself to death.
 
DreamingTheLive said:
Lol, most important on this list of course. Both for better, and lately for worse as ESPN is "ESPNing" itself to death.
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ESPN is dead to me. Instead of covering hockey (in any way, shape, or form), they'd rather have basketball players talking about football players talking about poker players.

Forge about... you know... broadcasting SPORTS coverage. Its gone the way of MTV.
 
RustedFox said:
ESPN is dead to me. Instead of covering hockey (in any way, shape, or form), they'd rather have basketball players talking about football players talking about poker players.

Forge about... you know... broadcasting SPORTS coverage. Its gone the way of MTV.
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Agree on the talking head points. Nobody cares what Steven A. Smith thinks about who is the top table tennis player in the world. Skip Bayless is a shell, of an actor, of a shell, of a shadow, of a story, of a myth, of a shell.

You're going to hate me, but waaaayyy less baseball....hockey coverage is just right haha....and you can't have enough college football....NFL is fine, but ESPN and its uber-saturation-mega-marketing machine are doing their best to kill my interest. I don't need 117 analysts talking about the Anquan Boldin trade for 48 straight hours.
 
Its hard for me to even be interested in football at any level anymore. There was a thread late last year about this that I piped off on.
 
DreamingTheLive said:
Agree on the talking head points. Nobody cares what Steven A. Smith thinks about who is the top table tennis player in the world. Skip Bayless is a shell, of an actor, of a shell, of a shadow, of a story, of a myth, of a shell.

You're going to hate me, but waaaayyy less baseball....hockey coverage is just right haha....and you can't have enough college football....NFL is fine, but ESPN and its uber-saturation-mega-marketing machine are doing their best to kill my interest. I don't need 117 analysts talking about the Anquan Boldin trade for 48 straight hours.
Click to expand...

Speaking of professional sports, you and Rusted are becoming professional thread hijackers 😀
 
SeekerOfTheTree said:
What percentage of radiologist don't have jobs because of it. The examples of use I have seen are to have rural reads go to academic centers or satellite centers go to hubs. Also have seen night coverage done by nighthawk service in Australia. You could find an example that is an exception just like their are examples of ERs run completely by mid levels. But it is not significant enough to impact demand or job outlook terribly because these are exceptions.

The point is supply and demand. If you increase supply too quickly demand will decrease.
Click to expand...

I'm not arguing anything EM but in rads it doesn't matter who doesn't have a job, there are better questions. How many reads post hour are expected today compared to 10 years ago? How much less ate they paid per read? Per repeat read? What are the productivity and salary effects from these?

I've heard radiologists that are very frustrated by these developments and many are because of increased competition and market pressures. 10 groups competing for a job makes the working conditions much different than if 2 groups are.

Many radiologists have mentioned they can't survive just doing reads and they need to diversify in the hospital with more responsible and procedures to thrive. It's a big deal.
 
JShephard said:
I'm not arguing anything EM but in rads it doesn't matter who doesn't have a job, there are better questions. How many reads post hour are expected today compared to 10 years ago? How much less ate they paid per read? Per repeat read? What are the productivity and salary effects from these?

I've heard radiologists that are very frustrated by these developments and many are because of increased competition and market pressures. 10 groups competing for a job makes the working conditions much different than if 2 groups are.

Many radiologists have mentioned they can't survive just doing reads and they need to diversify in the hospital with more responsible and procedures to thrive. It's a big deal.
Click to expand...

Dude why are we arguing this. I liked Lost. Point was lost a few posts ago. The point is just watch how many spots we open before we flood the market. I don't care about this I am matching tomorrow lol.
 
SeekerOfTheTree said:
Dude why are we arguing this. I liked Lost. Point was lost a few posts ago. The point is just watch how many spots we open before we flood the market. I don't care about this I am matching tomorrow lol.
Click to expand...

Lol. Congrats
 
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