New EM residencies

[bmickelsen]

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The following article was in today's EM today. Does anyone know if that means that all those states will be starting up an EM residency in the near future. I'm especially interested in the idea of Utah, so if anyone also knows any info about a possible residency there I'd love to hear.

{Emergency Medicine Residency Programs Likely to Benefit from Medicare Bill

Included in the Medicare reform bill approved by Congress last week was a provision that will help fund residency programs in small urban areas, and in states where the emergency medicine residency program is the only one in that state.

The bill, expected to become law on December 8, changes Graduate Medical Education (GME) rules, and expands emergency medicine residency programs.

Beginning July 1, 2005, the Secretary of Health and Human Services can start re-distributing a majority of the nation?s GME slots that have been unused for at least three years. The redistribution will include Medicare funds for the direct and indirect costs of the program. Emergency medicine residency directors can contact the Centers for Medicare and Medicaid Services as soon as possible to determine their programs' eligibility to receive the unused slots.

?This is an issue that ACEP has been working on for six years,? said Dr. Ann LaBelle, ACEP?s Congressional Affairs Director. ?More than nine emergency medicine residency programs are likely to benefit from this new law.?

Emergency medicine residency directors from Michigan, Louisiana, Nebraska, Oklahoma, Utah, Iowa, Alabama, Nevada, Kansas and New Hampshire participated with ACEP in designing a strategy to get funding for much needed training programs, Dr. LaBelle said.

?Studies have shown is that residents often stay and practice in areas near their residencies, so this change could have a positive impact on emergency medical services in these states,? she said.}

 

[Voxel]

I have a question. Can/will those unused residency slots be used to fund other specialties besides EM or is this bill worded so that only EM is included.

 

[southerndoc]

Will some programs expand to 4 year programs, or is the funding still limited to 3 years?

 

[Sheerstress]

I'm pretty sure funding will stay at 3 years. Programs that remain 4 years will have to simply eat the cost.

 

[DrQuinn]

ACEP is fighting very hard to make sure those extra spots do go to EM... met with the immediate past president of ACEP today.

Q, DO

 

[ERMudPhud]

Originally posted by bmickelsen

I'm especially interested in the idea of Utah, so if anyone also knows any info about a possible residency there I'd love to hear.

Erik Barton is supposed to be starting a residency at University of Utah but I don't know when they will be starting

 

[edinOH]

This may be a topic that needs it's own thread but, just how many EM residencies do we need? If programs continue to open at their current pace, especially if there is more federal funding to allow it, will we ultimately dilute the applicant pool to EM? And when that happens, will we dilute the value of being a residency trained EM physician? Ultimately, how badly will the market value of an EM trained physician be affected? It is something to think about.

The academics have their own agendas, and I think their motives are pure for the most part. They want to increase their training capacity and along with that stature in the field of academic medicine. Of course this also results in more revenues to the department/facility in multiple ways. The corporate EM mavens have the ear of ACEP (and no this is not a bash ACEP thread) and as a result, of many of the policy makers in Washington. So they too have an agenda when it comes to increasing the number of EM training positions in the U.S. More docs results in more candidates for physician practice spots. And it means more competition for those spots. And that means less bargaining power among the physicians. And that means more profit for the managers and/or less upward pressure on the reimbursement of the practicing physicians which will ultimately lead to a decrease in the value of being EM trained.

 

[NinerNiner999]

I agree with EdinOH. This might lead to a financial devaluation of being EM trained, and will most likely (in my opinion and as stated above) cause a relative dilution in EM applications - without a change in the difficulty of matching or overall value of our specialty. If my numbers are correct (and they probably aren't), 93% of those who apply to Emergency Medicine as "hard" applicants will match. The numbers are slightly lower for "soft" applicants, FMG's, and others. By my (ROUGH) estimate, I would say that ~25-30% of those who apply to EM OVERALL will not match due to the number of spaces available. Adding to that number the locations that do need EM residents and new EM physicians (Utah, etc), I think it might be reasonable to assume that these new spots will help to accomodate the match discrepancy in those who do apply, but will not increase interest in application to our chosen field.

Given that the interest in Emergency Medicine, while rising over the last few years, will more than likely stabilize, and newer markets will have a larger share of those who will be board certified, I think it is reasonable to assume that the "value" of Emergency Medicine training will increase in those new areas, and project overall to the country. However, the new availability of EM certified docs in new underserved areas might decrease the fincial compensation for those locales (I.E. EM salary in rural Utah may drop from $200/hr to $130/hr due to the increased presence of EM certified docs there. While this may decrease the attractiveness of working in those locations, it may eventually increase the competition in more popular locations, and with an already established work force full of EM docs not willing to suffer a salary change in those areas, the market could most likely remain the same as it is now.

 

[DrQuinn]

Like I mentioned, I met with the ACEP immeidate past president today... he said that there are both pros and cons, and that ACEP will likely create a task force to figure out the perfect balance between too many EM residencies and just enough to meet the nation's demand. I personally would only like to see a few more, as I don't want the market saturated in ten years... the market will be good for atleast 3-4 more years (so have said some headhunters).

Q, DO

 

[realruby2000]

Originally posted by NinerNiner999
If my numbers are correct (and they probably aren't), 93% of those who apply to Emergency Medicine as "hard" applicants will match. The numbers are slightly lower for "soft" applicants,

what do u exactly mean by "hard" and "soft" applicants?

 

[Apollyon]

"Hard" applicants are those that apply for one specialty only, and "soft" are those that apply for more than one. This doesn't include prelim or transitional programs, but a person that applies for EM and, say, IM categorical spots, is a "soft" applicant. The "hard" applicant is "EM or bust!"

 

[24858]

Hey Mickelsen arent you supposed to be studying for Heme and OPP?

 

[NinerNiner999]

Originally posted by QuinnNSU
ACEP will likely create a task force to figure out the perfect balance between too many EM residencies and just enough to meet the nation's demand.
Q, DO

I have faith in ACEP - they wouldn't shoot us (or themselves in the foot) 😉... I hope. Where did you meet "the guy"?

 

[bmickelsen]

ERMudPhud
Thanks for the info about Erik Barton. I contacted him, and he said that Utah will voting on the issue this December. With the hopes of opening a residency in July of 2005.

 

[wook]

Hopefully the Utah thing will fly. It sounds promising!!

Wook

 

[DrQuinn]

Originally posted by NinerNiner999
I have faith in ACEP - they wouldn't shoot us (or themselves in the foot) 😉... I hope. Where did you meet "the guy"?

We (the whole EM residency, er, 6 interns) and some attendings met out with him for dinner, and he lectured to us for grand rounds. Nice guy, really motivating. Everyone join ACEP dammit.

Q, DO

 

[Sessamoid]

Originally posted by NinerNiner999
I have faith in ACEP - they wouldn't shoot us (or themselves in the foot) 😉... I hope. Where did you meet "the guy"?

I'm an ACEP member, but don't put too much faith in them to always do the right thing for you. They have historically sometimes favored the interests of corporate EM, and not always the individual docs. That tendency was the impetus for the formation (and growth) of AAEM (of which I'm also a member).

 

[roja]

Interesting point sessamoid . I don't have enough exposure at this point, but I think that while the intentions of many organizations are good, they are still bureaucracies to a point. and the 'road to hell is paved with good intentions'. I don't think pure cynicism is warranted but a touch doesn't hurt.

I know that UTHSCSA is starting a joint civilian EM residency in 2005.... Don't know about the funding though....

 

[Sutureboy]

The problem is that there really is not a good way to limit the number of programs or prevent the start-up of new residencies. ACEP or AAEM have no control over this. The RRC can?t block the creation of a new program if it meets the special requirements without being sued. So the only legal method of restricting growth would be for the RRC to toughen the requirements but that would be more likely to cause existing programs to crash than prevent new programs. Another way to keep down the number of specialists would be for ABEM to toughen the exam to limit the number of board certified specialists. Obviously both of these actions would be very prejudicial to residents in training. 😕

 

[elkchaser]

Any news on a potential EM residency in Utah (or Nevada)?

 

[Hidalgo]

Utah will be starting their EM program July, 2005

 

[NotChoCheez!]

Sounds good. How do you know? I haven't seen anything on FREIDA. I've only heard rumors--nothing official.

 

[DrDre']

Is Utah official. I had last heard they still had to jump through a bunch more hoops...