NEW EMERGENCY MEDICINE RESIDENCY

[1987ram]

Hey Everyone!

For those looking to add another EM Residency to your application list, take a look at Northwell Health's newest program at Southside Hospital.

It is a 3 year EM program recruiting for its inaugural class this year. ACGME certified with the backing of one of the nation's larges Health Systems as well as the Zucker School of Medicine at Hofstra/Northwell. Located in Bayshore, New York, on the south shore of Long Island.

All applications are welcome through ERAS

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[NYEMMED]

Hey Everyone!

For those looking to add another EM Residency to your application list, take a look at Northwell Health's newest program at Southside Hospital.

It is a 3 year EM program recruiting for its inaugural class this year. ACGME certified with the backing of one of the nation's larges Health Systems as well as the Zucker School of Medicine at Hofstra/Northwell. Located in Bayshore, New York, on the south shore of Long Island.

All applications are welcome through ERAS

When would this program start?

I think we are killing our specialty with so many new residencies

 

[Dr Mantis Toboggan]

Who approves new programs? CORD? Do they ever turn new program applications down?

When would this program start?

I think we are killing our specialty with so many new residencies

 

[Apollyon]

Who approves new programs? CORD?

I thought it was ACGME.

 

[1987ram]

ACGME approves new programs. This program is ACGME approved. The first class of residents will start in July 2019, so applications are being accepted now.

 

[askamsky51]

Is it CMG sponsored?

 

[NYEMMED]

Is it CMG sponsored?

Well Technically Northwell is a hospital system and they staff their own docs In the ED. But Northwell is also a large CMG themselves as they own 15+ hospitals in the NY area and therefore are basically a large CMG

 

[Fox800]

I’ll be the voice of unpopular opinion.

We don’t. Need. Any. More. Residency programs.

 

[RustedFox]

I’ll be the voice of unpopular opinion.

We don’t. Need. Any. More. Residency programs.

While I'm inclined at first blush to agree, hold-up.
We need a few more residency programs, because as the population grows, we need physicians to fill that demand. The ancient ones are retiring, or transitioning to their second gigs, or whatever.

What we need are a few more GOOD residency programs, without the filthy mitts of EmCare/Envision or (insert CMG here) in the pot.

University of Piedmont General Level 1 Trauma Center is probably a good site.
EastShore Asswipe Medical Center without enough volume to have another residency program... probably isn't.

 

[Fox800]

While I'm inclined at first blush to agree, hold-up.
We need a few more residency programs, because as the population grows, we need physicians to fill that demand. The ancient ones are retiring, or transitioning to their second gigs, or whatever.

What we need are a few more GOOD residency programs, without the filthy mitts of EmCare/Envision or (insert CMG here) in the pot.

University of Piedmont General Level 1 Trauma Center is probably a good site.
EastShore Asswipe Medical Center without enough volume to have another residency program... probably isn't.

We already have like 170+/180+ programs in operation. Locums wages are starting to fall. Texas (the Valhalla of EM) is basically totally full in the major cities - a far cry from just 2-3 years ago. NPs and PAs continue to flood the market. We need fewer programs (especially at craptastic HCA sites), not more.

 

[LeroyJenkinsMD]

There are not enough EM residencies because rural sites are still staffed primarily by non ABEM physicians. The goal is to have every ED staffed with ABEM physicians because anything less would be bad for patient care.

 

[Fox800]

There are not enough EM residencies because rural sites are still staffed primarily by non ABEM physicians. The goal is to have every ED staffed with ABEM physicians because anything less would be bad for patient care.

Pay an attractive (and fair) wage and you'll attract folks or locums physicians. Sorry, most of us don't want to work away from home, 4 hours from the closest airport for $175 an hour.

You're never going to get every hospital ever entirely staffed with ABEM-boarded physicians. A noble goal, but it won't happen. Not until rural places in unattractive areas start ponying up. It's too easy to get other folks to do it, or midlevels.

 

[Brigade4Radiant]

There are not enough EM residencies because rural sites are still staffed primarily by non ABEM physicians. The goal is to have every ED staffed with ABEM physicians because anything less would be bad for patient care.

Lol yet it’s okay for midlevels to see patients?

Also it’s not like a highly educated individual wants to be in a rural area. It would just drive demand for competitive areas down and a lot of these rural areas.

Existing residencies should and do expand more which ensures quality control now we have situations like Florida where HCA hospitals pump out residencies like hot cakes.

Yesterday the internal residency program director was begging me not to admit patients to the private hospital group as they don’t have enough patients on their census for the last week.

An academic internist looking at the ED for more patients! This is why CMG is bad for medicine and this residency started 2 years ago and they already want to add family medicine lol

 

[RustedFox]

We already have like 170+/180+ programs in operation. Locums wages are starting to fall. Texas (the Valhalla of EM) is basically totally full in the major cities - a far cry from just 2-3 years ago. NPs and PAs continue to flood the market. We need fewer programs (especially at craptastic HCA sites), not more.

Yeah, I'm with you. Stay with me, hombre.
Two more hospitals are being built in the "next county south of here" right now.
My primary job site has lost 2 docs this year due to retirement, and another has gone and is now focused on his "men's health clinic".
I used to enjoy 130 +/- 5 hours a month. Now, its "can you work THIS one because we lost Dr. Nightguy?"
The PA and NP crowd needs to be slapped back to where they belong, which - (in a lot of cases) is nowhere in medicine. I don't want "Jenny McJennyson, ABCD-NP" to ever send me another patient to the ER.
We need more physicians. Properly trained physicians.

 

[miacomet]

There are enough craptastic EM residencies in NYC and LI without adding another one. Southside is not huge- 341 beds. They start residencies out there because it's cheaper than hiring PAs and the work is so miserable the attendings need more help or they burn to a crisp.

 

[RustedFox]

There are enough craptastic EM residencies in NYC and LI without adding another one. Southside is not huge- 341 beds. They start residencies out there because it's cheaper than hiring PAs and the work is so miserable the attendings need more help or they burn to a crisp.

Yeah, now I think we're hitting on the truly important theme; the quality of residency education.
Can anyone chime in as to just how on Dog's-Green-Earth these HCA/EmCare residencies are becoming accredited?
There HAS to be some back-door dealing here with old, fat vasculopaths who are making millions on the deal.

 

[southerndoc]

There are not enough EM residencies because rural sites are still staffed primarily by non ABEM physicians. The goal is to have every ED staffed with ABEM physicians because anything less would be bad for patient care.

This is true. I summarized it in one of my posts the number retiring, entering market, PA's, etc. I *think* it was on SDN, but may not have been. I've been up since 4 am, it's 12:30 am and I'm at the tail end of a night shift. I'm a little dysconbobulated right now to know.

 

[TinkleStinkle]

I couldn't find this program on ERAS...any assistance would be great!


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[1987ram]

I couldn't find this program on ERAS...any assistance would be great!


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ERAS ID 1103500216

 

[deleted436726]

Applied

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[JMOANIAKT]

Hey Everyone!

For those looking to add another EM Residency to your application list, take a look at Northwell Health's newest program at Southside Hospital.

It is a 3 year EM program recruiting for its inaugural class this year. ACGME certified with the backing of one of the nation's larges Health Systems as well as the Zucker School of Medicine at Hofstra/Northwell. Located in Bayshore, New York, on the south shore of Long Island.

All applications are welcome through ERAS

The website is a little bare-bones. Where can we find out more about curriculum information. Will other clinical sites be involved?

Thank you.

 

[MechEDoc]

There are not enough EM residencies because rural sites are still staffed primarily by non ABEM physicians. The goal is to have every ED staffed with ABEM physicians because anything less would be bad for patient care.

Pay an attractive (and fair) wage and you'll attract folks or locums physicians. Sorry, most of us don't want to work away from home, 4 hours from the closest airport for $175 an hour.

You're never going to get every hospital ever entirely staffed with ABEM-boarded physicians. A noble goal, but it won't happen. Not until rural places in unattractive areas start ponying up. It's too easy to get other folks to do it, or midlevels.

Many of these hospitals can't afford an ER physician and probably shouldn't have an emergency department. If one takes a rough number of 2 patients / hour as general industry productivity, then you're going to need at least 17,520 patients per year. However, there isn't a consistent 24 hour distribution of patients. Most show up between 10 am and 10 pm, leaving the wee hours with little work to be done. That means you still can't afford a physician at night with 17,520 patients a year. If 70% of patients are during the peak 12 hours of the day, then you're going to need ~38k patients per year to afford to have full time physician staffing with a least 2 pph. Most rural ERs don't see these volumes. We don't need more doctors for these places... we don't need these places. I'm more than happy to allow other people to fight over the scraps to ensure that high quality work sites are not over saturated with ABEM qualified physicians. You should be seeing 2 pph, grossing a professional fee of ~$150/pt, and having 15-30% overhead leaving you with $240-$270/hour.

At best these places could be served by a local well rounded family medicine doc or a good PA that has tele health backup. There are many complicated things that can be designed out of emergency medicine. Intubation -> LMA or cric, LP? Nope - treat and transfer, PCR a LP later.

Ever see ads for these places? "Sportsman's paradise!" (i.e. the only thing do here is to shoot at things). I'll pass. Can you imagine another industry where people demand doctoral level services to be employed part time while putting in full time hours and living in the sticks so that local residents aren't inconvenienced with a drive? "It's my human right to have a crop geneticist available to figure out my blight in Burns Oregon! I'm not driving anywhere!"...."I'm entitled to a patent lawyer in Paris Maine!"

 

[LeroyJenkinsMD]

Many of these hospitals can't afford an ER physician and probably shouldn't have an emergency department. If one takes a rough number of 2 patients / hour as general industry productivity, then you're going to need at least 17,520 patients per year. However, there isn't a consistent 24 hour distribution of patients. Most show up between 10 am and 10 pm, leaving the wee hours with little work to be done. That means you still can't afford a physician at night with 17,520 patients a year. If 70% of patients are during the peak 12 hours of the day, then you're going to need ~38k patients per year to afford to have full time physician staffing with a least 2 pph. Most rural ERs don't see these volumes. We don't need more doctors for these places... we don't need these places. I'm more than happy to allow other people to fight over the scraps to ensure that high quality work sites are not over saturated with ABEM qualified physicians. You should be seeing 2 pph, grossing a professional fee of ~$150/pt, and having 15-30% overhead leaving you with $240-$270/hour.

At best these places could be served by a local well rounded family medicine doc or a good PA that has tele health backup. There are many complicated things that can be designed out of emergency medicine. Intubation -> LMA or cric, LP? Nope - treat and transfer, PCR a LP later.

Ever see ads for these places? "Sportsman's paradise!" (i.e. the only thing do here is to shoot at things). I'll pass. Can you imagine another industry where people demand doctoral level services to be employed part time while putting in full time hours and living in the sticks so that local residents aren't inconvenienced with a drive? "It's my human right to have a crop geneticist available to figure out my blight in Burns Oregon! I'm not driving anywhere!"...."I'm entitled to a patent lawyer in Paris Maine!"

Lol, I agree. My post was half sarcasm. Just wanted to see some support for local family docs that do a good job with the resources at hand. However, if you guys are going to artificially create a shortage, just a friendly reminder to not kick the doctors picking up the slack.

 

[Rekt]

When would this program start?

I think we are killing our specialty with so many new residencies

I’ll be the voice of unpopular opinion.

We don’t. Need. Any. More. Residency programs.

We already have like 170+/180+ programs in operation. Locums wages are starting to fall. Texas (the Valhalla of EM) is basically totally full in the major cities - a far cry from just 2-3 years ago. NPs and PAs continue to flood the market. We need fewer programs (especially at craptastic HCA sites), not more.

I'm a current EM applicant and even I think this is horrible. HCA is popping out new programs like a 90 year old with C. diff to create cheap poorly trained labor. There are seriously way too many EM programs opening. From all my aways, I've consistently been hearing how most of the seniors have been having difficulty finding jobs in their select areas/cities and are having to find jobs 1-2hrs outside anywhere livable.

 

[alpinism]

Many of these hospitals can't afford an ER physician and probably shouldn't have an emergency department. If one takes a rough number of 2 patients / hour as general industry productivity, then you're going to need at least 17,520 patients per year. However, there isn't a consistent 24 hour distribution of patients. Most show up between 10 am and 10 pm, leaving the wee hours with little work to be done. That means you still can't afford a physician at night with 17,520 patients a year. If 70% of patients are during the peak 12 hours of the day, then you're going to need ~38k patients per year to afford to have full time physician staffing with a least 2 pph. Most rural ERs don't see these volumes. We don't need more doctors for these places... we don't need these places. I'm more than happy to allow other people to fight over the scraps to ensure that high quality work sites are not over saturated with ABEM qualified physicians. You should be seeing 2 pph, grossing a professional fee of ~$150/pt, and having 15-30% overhead leaving you with $240-$270/hour.

At best these places could be served by a local well rounded family medicine doc or a good PA that has tele health backup. There are many complicated things that can be designed out of emergency medicine. Intubation -> LMA or cric, LP? Nope - treat and transfer, PCR a LP later.

Ever see ads for these places? "Sportsman's paradise!" (i.e. the only thing do here is to shoot at things). I'll pass. Can you imagine another industry where people demand doctoral level services to be employed part time while putting in full time hours and living in the sticks so that local residents aren't inconvenienced with a drive? "It's my human right to have a crop geneticist available to figure out my blight in Burns Oregon! I'm not driving anywhere!"...."I'm entitled to a patent lawyer in Paris Maine!"

This.

Many of these rural ERs are barely seeing 5,000 patients a year. When you do the math thats roughly 13 patients a day the vast majority of whom have minor complaints that could easily be seen in a PCP's office. Not surprisingly its nearly impossible for them to offer a fair wage which is why you see all these ads for $120/hr and 24 hr shifts.

People love to talk about the physician shortage but the reality is that these places have no business operating an ER with so few patients. The problem is again our american culture of demanding convenient 24/7 access to medical services no matter the cost or quality of care.

 

[alpinism]

I'm a current EM applicant and even I think this is horrible. HCA is popping out new programs like a 90 year old with C. diff to create cheap poorly trained labor. There are seriously way too many EM programs opening. From all my aways, I've consistently been hearing how most of the seniors have been having difficulty finding jobs in their select areas/cities and are having to find jobs 1-2hrs outside anywhere livable.

Multiple people from my residency class had to take jobs with 1+ hour commutes from their homes.

All the spots at the mothership hospital were full so they have to "do their time" at the rural site.

 

[GeneralVeers]

How about we allow HCA to start residencies if they agree to fund rural hospitals in their areas so they can hire keep 24 hour ED doc coverage at $250/hr?

 

[miacomet]

PEM seems to be in really high demand right now- I see more job listings than for EM, and pay has caught up. I guess it's a marketing thing; I don't think PEM docs are great with really sick patients or traumas. But there are definitely tons of PEM jobs if anyone is interested in the fellowship.

 

[Hercules]

PEM seems to be in really high demand right now- I see more job listings than for EM, and pay has caught up. I guess it's a marketing thing; I don't think PEM docs are great with really sick patients or traumas. But there are definitely tons of PEM jobs if anyone is interested in the fellowship.

Peds EM? I may just be far removed from the job search (and happy to be educated if that’s the case) but I’ve never seen peds EM offer rates competitive with community adult EM. There may be isolated spots where they do, but the acuity is so low that they usually can’t command a similar income.


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[miacomet]

Peds EM? I may just be far removed from the job search (and happy to be educated if that’s the case) but I’ve never seen peds EM offer rates competitive with community adult EM. There may be isolated spots where they do, but the acuity is so low that they usually can’t command a similar income.


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I hope you are right. I don't even get why PEM is a field. They can't handle acuity.

 

[GonnaBeADoc2222]

I hope you are right. I don't even get why PEM is a field. They can't handle acuity.

Hate to say it as I have PEM friends, but can't agree more. Every airway handled by a PEM person is "tricky." Sick children are best left to EM trained folks for initial stabilization with guidance from real "sick kid" doctors - aka PICU. PEM is glorified clinic.

 

[miacomet]

Hate to say it as I have PEM friends, but can't agree more. Every airway handled by a PEM person is "tricky." Sick children are best left to EM trained folks for initial stabilization with guidance from real "sick kid" doctors - aka PICU. PEM is glorified clinic.

Agreed 100%. It's absurd.

 

[AlmostAnMD]

I will only support this if they build a new medical school on campus

 

[Old_Mil]

Is it CMG sponsored?

An important question to ask.

 

[deleted547339]

I do not think this thread went the way OP intended it to....

 

[EM Junkie]

Agree 1000% with what’s been laid out here. There are far too many residencies cropping up, especially those run by the CMGs. And we’re all happy to follow along with ACEP leading the way.

The sad part is - what can we do about it? To all the residents and medical students out there - don’t do it . Don’t sell out to these CMG sponsored residencies (AKA slave factories). /endrant

 

[deleted547339]

Agree 1000% with what’s been laid out here. There are far too many residencies cropping up, especially those run by the CMGs. And we’re all happy to follow along with ACEP leading the way.

The sad part is - what can we do about it? To all the residents and medical students out there - don’t do it . Don’t sell out to these CMG sponsored residencies (AKA slave factories). /endrant

That’s not a viable solution . If your option is go to a corporate sponsored soul sucking residency for 3-4 years (side note: I don’t see why any CMG would opt for 3 over 4 years based on their motives) then be a marginally competent EP through hard work/reading/motivation vs. doing FP or psych or whatever doesn’t get filled, it’s not hard to imagine what MS4s will pick. The answer has to be stopping it before it pops up.

Maybe we need to petition ABEM that a certificate of need be issued to start a new program similar to what some states require for hospitals.

 

[EM Junkie]

Agree wholeheartedly. Sorry my initial statement was not clear.

Residents will continue to go to these programs as long as they keep opening. As other have stated - Good luck getting a job anywhere in any metropolitan area anymore, though.

 

[GeneralVeers]

Agree wholeheartedly. Sorry my initial statement was not clear.

Residents will continue to go to these programs as long as they keep opening. As other have stated - Good luck getting a job anywhere in any metropolitan area anymore, though.

Right. I went to the "worst" residency in the country back in 2005. The alternative was not doing EM. Of course people are going to go into these programs, as our graduate medical education system leaves people with no other options if they want to do a specific specialty.

 

[miacomet]

That’s not a viable solution . If your option is go to a corporate sponsored soul sucking residency for 3-4 years (side note: I don’t see why any CMG would opt for 3 over 4 years based on their motives) then be a marginally competent EP through hard work/reading/motivation vs. doing FP or psych or whatever doesn’t get filled, it’s not hard to imagine what MS4s will pick. The answer has to be stopping it before it pops up.

Maybe we need to petition ABEM that a certificate of need be issued to start a new program similar to what some states require for hospitals.

The proliferation of sketchy residencies is a sign of a specialty in trouble. I would urge students to reconsider EM unless they are absolutely set on the specialty and can see themselves doing nothing else (unlikely, as EM docs tend to have shortish careers and often transition into HPM etc, unlike surgeons). And don't pooh-pooh Psych- it's increasingly competitive, there's a huge shortage, and docs can basically write their own tickets and have a cash practice with no CME oversight. I know more than one EM doc who wishes they had done Psych, and at least one who has switched.

 

[TinkleStinkle]

Where can we get more info this program?


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[OneTwoThreeFour]

The proliferation of sketchy residencies is a sign of a specialty in trouble. I would urge students to reconsider EM unless they are absolutely set on the specialty and can see themselves doing nothing else (unlikely, as EM docs tend to have shortish careers and often transition into HPM etc, unlike surgeons). And don't pooh-pooh Psych- it's increasingly competitive, there's a huge shortage, and docs can basically write their own tickets and have a cash practice with no CME oversight. I know more than one EM doc who wishes they had done Psych, and at least one who has switched.

Any evidence for this? I know you've been disgruntled about EM in the past but no need to boogeyman applicants with statements like this...

 

[miacomet]

Any evidence for this? I know you've been disgruntled about EM in the past but no need to boogeyman applicants with statements like this...

Evidence for what? That I know a couple of EM docs who don't like EM, one of whom wishes he'd done psych, and another who switched to psych? I don't think they wish to give a sworn statement- what kind of evidence are you looking for? The shortage of psychiatrists (especially child psych) is public knowledge- once again I'm not sure what kind of evidence you want.

Whether a proliferation of mediocre, CMG-sponsored residencies is a sign of a specialty in trouble is a personal opinion. I don't think it's something for which there is "evidence" beyond the obvious and factual proliferation of CMG-sponsored residencies. To me that's a sign of a specialty that's lowering its standards and entering a bubble phase. Others may interpret it differently.

 

[OneTwoThreeFour]

Evidence for what? That I know a couple of EM docs who don't like EM, one of whom wishes he'd done psych, and another who switched to psych? I don't think they wish to give a sworn statement- what kind of evidence are you looking for? The shortage of psychiatrists (especially child psych) is public knowledge- once again I'm not sure what kind of evidence you want.

Whether a proliferation of mediocre, CMG-sponsored residencies is a sign of a specialty in trouble is a personal opinion. I don't think it's something for which there is "evidence" beyond the obvious and factual proliferation of CMG-sponsored residencies. To me that's a sign of a specialty that's lowering its standards and entering a bubble phase. Others may interpret it differently.

I meant specifically for what I bolded, because you're an attending and shouldn't be posting opinion as fact. I accept that you know physicians that became disenchanted with emergency medicine. But I have met residents and attendings on the interview trail who switched out of other fields. I have a resident in my program who spent over a decade practicing as an IM physician who decided to come to emergency medicine. We can all swap stories of people who changed their minds on what field of medicine to do.

 

[enalli]

I hope you are right. I don't even get why PEM is a field. They can't handle acuity.

I guess I'm in the minority here in that I was trained by very competent PEM physicians who managed acute patients well.

At the end of the day, your average EM residency has 6-8 months of PEM, while a PEM fellowship has 20-22 months. This doesn't take into account pre-fellowship experience. All that exposure counts for something, in my opinion.

 

[Apollyon]

I guess I'm in the minority here in that I was trained by very competent PEM physicians who managed acute patients well.

At the end of the day, your average EM residency has 6-8 months of PEM, while a PEM fellowship has 20-22 months. This doesn't take into account pre-fellowship experience. All that exposure counts for something, in my opinion.

And yet, it doesn't. As is amply displayed, PEM just don't get the sick kids, or the procedures.

 

[miacomet]

I meant specifically for what I bolded, because you're an attending and shouldn't be posting opinion as fact. I accept that you know physicians that became disenchanted with emergency medicine. But I have met residents and attendings on the interview trail who switched out of other fields. I have a resident in my program who spent over a decade practicing as an IM physician who decided to come to emergency medicine. We can all swap stories of people who changed their minds on what field of medicine to do.

I consider an increasing number of EM residencies to be sketchy. That is my opinion. I also consider these sketchy (in my opinion) residencies to be a sign of a specialty in trouble. These statements are (obviously) my opinion. Better?

 

[BoardingDoc]

I meant specifically for what I bolded, because you're an attending and shouldn't be posting opinion as fact.

I don't think anyone assumes that people on this forum are solely posting facts and abstaining from posting their opinions.

I suspect that you will also find that people express opinions without explicitly stating "this is my opinion" in real life.

 

[OneTwoThreeFour]

I don't think anyone assumes that people on this forum are solely posting facts and abstaining from posting their opinions.

I suspect that you will also find that people express opinions without explicitly stating "this is my opinion" in real life.

When attendings say things-both in real life and on this forum-from their position as attendings I have actually found that they make it very clear when something is their preference/belief vs something that is supported. Particularly when they are specifically advising junior residents/medical students.

 

[Rekt]

Any evidence for this? I know you've been disgruntled about EM in the past but no need to boogeyman applicants with statements like this...

I'm not sure how you could possibly think this is a good thing? EM will end up like pathology and rad/onc. Too much supply without any demand plus the dangers of continued CMG proliferation, you'll be barely making enough to pay your loans and living in an apartment.