Preliminary Data - ERAS 2023 - It's really bad

[Fecal_Occult]

Number of applicants for EM declines further...

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[bravotwozero]

The horror show / slow motion train wreck continues

 

[southerndoc]

So we complain about too many residents graduating and then complain about the decline in applicants? What gives? Maybe it'll decline more so many programs go unfilled.

 

[Fecal_Occult]

So we complain about too many residents graduating and then complain about the decline in applicants? What gives? Maybe it'll decline more so many programs go unfilled.

We need less residency spots, not less applicants. The difference is that unfilled spots become filled, mostly with less competitive applicants. And so the job market becomes even MORE saturated, and the cycle repeats until we're all screwed.

A saturated job market means less bargaining power. This can lead to a whole slew of negative consequences.
- No jobs for new grads (especially in big cities)
- A decrease in salary
- Worse working conditions
- More expendable
- Etc.

This is the big picture. Private equity is gradually taking over EM and any leverage that EM physicians do have to advocate for patients or themselves is disappearing.

 

[RustedFox]

So we complain about too many residents graduating and then complain about the decline in applicants? What gives? Maybe it'll decline more so many programs go unfilled.

I mean, this is what I'm hoping for.
I'm going to start to do some lecturing at our local medical school, and I'm going to be very clear when the question is asked, that the answer is: "No, don't choose EM."

 

[RustedFox]

We need less residency spots, not less applicants. The difference is that unfilled spots become filled, mostly with less competitive applicants. And so the job market becomes even MORE saturated, and the cycle repeats until we're all screwed.

A saturated job market means less bargaining power. This can lead to a whole slew of negative consequences.
- No jobs for new grads (especially in big cities)
- A decrease in salary
- Worse working conditions
- More expendable
- Etc.

This is the big picture. Private equity is gradually taking over EM and any leverage that EM physicians do have to advocate for patients or themselves is disappearing.

Yeah - he knows this, amigo.

 

[cyanide12345678]

Good for everyone choosing to walk away from EM. They are making a great decision. Good for them.

Now if only the open spots don't fill when SOAP happens. Fingers crossed.

 

[xaelia]

... still plenty more applicants than spots.

I don't think EM programs are going to deliberately leave spots unfilled; Audrey II needs fresh meat.

 

[GatorCHOMPions]

So we complain about too many residents graduating and then complain about the decline in applicants? What gives? Maybe it'll decline more so many programs go unfilled.

Notice the sharp decline in US MDs yet increase in IMGs. What type of applicants will be especially happy to just have a job? “The future of EM is bright”.

 

[Rekt]

We need less residency spots, not less applicants. The difference is that unfilled spots become filled, mostly with less competitive applicants. And so the job market becomes even MORE saturated, and the cycle repeats until we're all screwed.

A saturated job market means less bargaining power. This can lead to a whole slew of negative consequences.
- No jobs for new grads (especially in big cities)
- A decrease in salary
- Worse working conditions
- More expendable
- Etc.

This is the big picture. Private equity is gradually taking over EM and any leverage that EM physicians do have to advocate for patients or themselves is disappearing.

We all know this. Loss of applicants is at least a start. No one is complaining about this. It's great. Congratulations to those smart enough to walk.

ACEP, who also knows, continues to do nothing about too many residencies. Literally not even one single thing.

The reverse market correction is going to be swift. After this past years post covid boom I'm already seeing and hearing a lot of jobs that want someone now and stating they're already full for next summer. I give it 2-3 more cycles before we look like we did two years ago and the workforce report becomes true.

 

[RustedFox]

We all know this. Loss of applicants is at least a start. No one is complaining about this. It's great. Congratulations to those smart enough to walk.

ACEP, who also knows, continues to do nothing about too many residencies. Literally not even one single thing.

The reverse market correction is going to be swift. After this past years post covid boom I'm already seeing and hearing a lot of jobs that want someone now and stating they're already full for next summer. I give it 2-3 more cycles before we look like we did two years ago and the workforce report becomes true.

As in, "we hired a resident; but they're not graduated yet"?

 

[RustedFox]

I wonder how long it will be until we start seeing these HCA Trashcan grads really flame out. Like, I know of at least one instance where the director has "effing had it with THAT one", and word is getting out.

 

[RustedFox]

... still plenty more applicants than spots.

I don't think EM programs are going to deliberately leave spots unfilled; Audrey II needs fresh meat.

Feed me, Seymour.

 

[Arcan57]

I wonder how long it will be until we start seeing these HCA Trashcan grads really flame out. Like, I know of at least one instance where the director has "effing had it with THAT one", and word is getting out.

The question becomes, "Does that lead to any sort of widespread changes?" How much liability exposure does a billion dollar hospital system have for the actions of a subcontractor? I think having a plethora of low quality docs that you can easily deflect systemic issues onto and then jettison in an almost consequence free manner may prove useful to the hospitals. How many C-suite members are salivating at the thought of firing an EM doc for missing a CMS metric? The only thing that's stopping them now is that we're still something of a pain in the rear to replace.

 

[GonnaBeADoc2222]

I wonder how long it will be until we start seeing these HCA Trashcan grads really flame out. Like, I know of at least one instance where the director has "effing had it with THAT one", and word is getting out.

The fallacy is believing hospitals or CMS care about patients.

 

[Franzd'Epinay]

Right after finishing residency, I was talking to the chair of another specialty in a different hospital and she said "you know, back in my day, the ER was for the people who couldn't cut it in any other field; I guess now it's seen as a desirable specialty."

It's interesting to see that we will soon return to the old status quo. EM had a good 10-15 year run of respect, I guess.

 

[alpinism]

I know its controversial but I really do believe EM stopped being a legitimate specialty within the last 10 years.

That's when all these new residency programs started popping up at community hospitals run by attendings that spend their shifts practicing mindless orderset medicine on primary care patients while giving away the management of life threatening emergencies to other specialists.

All because it pays better to be seeing 3 PPH of level 3s versus 1 PPH of level 1s in the emergency department.

 

[evert1de101]

As long as caribbean grads still match and ACEP gets to hire celebrity speakers and host CMG parties, all is well.

 

[deleted206819]

As long as caribbean grads still match and ACEP gets to hire celebrity speakers and host CMG parties, all is well.

The only part of this statement that I find offensive is that Caribbean grads are not at the same caliber of American grads.

As a Caribbean grad myself, I worked as hard if not harder than American grads to get into residency and then throughout.

You don’t find many Caribbean grads in EM because the doors are shut almost immediately and those who get through are a higher caliber.

 

[RustedFox]

The only part of this statement that I find offensive is that Caribbean grads are not at the same caliber of American grads.

As a Caribbean grad myself, I worked as hard if not harder than American grads to get into residency and then throughout.

You don’t find many Caribbean grads in EM because the doors are shut almost immediately and those who get through are a higher caliber.

Thanks. [Brushes dirt off shoulders].

Hey! Wanna bring this full circle by discussing "diversity" and US med school admissions? Lol.

 

[thegenius]

I know its controversial but I really do believe EM stopped being a legitimate specialty within the last 10 years.

I think EM is a failed paradigm. Main reason is usage of the ER is almost never for emergencies. And that behavior is desired and accepted. Hospitals and our health care ethos have let that happen.

 

[thegenius]

As a Caribbean grad myself, I worked as hard if not harder than American grads to get into residency and then throughout.

That is a poo-flinging statement if there ever was one.

Did you work harder than me? I worked pretty damn hard to get into an Ivy League residency. I think I worked as hard as you, perhaps harder.

 

[RustedFox]

That is a poo-flinging statement if there ever was one.

Did you work harder than me? I worked pretty damn hard to get into an Ivy League residency. I think I worked as hard as you, perhaps harder.

Pfft.
If you *really* worked hard, you would have gotten into a POWERHOUSE residency.

 

[AlmostAnMD]

Pfft.
If you *really* worked hard, you would have gotten into a POWERHOUSE residency.

I hope that meme never goes away

That troll gave so much more to this site than he knew

 

[RustedFox]

I hope that meme never goes away

That troll gave so much more to this site than he knew

I was thinking that same thing when I typed my reply.

"Midwest Powerhouse Residency".

 

[Franzd'Epinay]

That is a poo-flinging statement if there ever was one.

Did you work harder than me? I worked pretty damn hard to get into an Ivy League residency. I think I worked as hard as you, perhaps harder.

No one had it worse than me or worked harder than me. I was born at a very young age. The first two years of my life, I couldn't even walk. I couldn't even fend for myself. There would be times--I remember it so well--there would be times that I would wake up, and there would just be **** in my pants!

 

[EMhawkeye]

That is a poo-flinging statement if there ever was one.

Did you work harder than me? I worked pretty damn hard to get into an Ivy League residency. I think I worked as hard as you, perhaps harder.

Was it a “powerhouse” residency? Lol

I still love laughing at the people who think the name on their diploma makes them a better physician or a smarter person. Watch out with your nose so much in the air. A small rainstorm may cause drowning.
Quite frankly I find people who succeed despite the name on their diploma, to be more interesting people and have more grit.
I also find it funny that people who come from “ivy league” programs useless in a community ed as they have no specialist to farm everything out to. When you have ortho do all your reductions, you’re cutting your legs from under yourself when you’re a solo doc in a community shop. Pun intended.

 

[Fpg1245]

I think EM is a failed paradigm. Main reason is usage of the ER is almost never for emergencies. And that behavior is desired and accepted. Hospitals and our health care ethos have let that happen.

Probably one of the more insightful posts.

Maybe it’s better described as UM. Urgent Medicine. Or ASAP Medicine. Or CM for convieniance medicine.

 

[bravotwozero]

I know its controversial but I really do believe EM stopped being a legitimate specialty within the last 10 years.

This is certainly arguable.

Putting aside the merits of the statement itself, if this is true, then does anyone really have a leg to stand on when docs talk about leaving the field and starting their own infusion clinic, and they assail them for being unethical, despite full disclosure?

Because that’s precisely what I saw happen in some of the other threads.

 

[thegenius]

Pfft.
If you *really* worked hard, you would have gotten into a POWERHOUSE residency.

Yea I know. Interviews at the POWERHOUSE residencies even told me as much.

I just didn't work hard enough.

 

[thegenius]

Was it a “powerhouse” residency? Lol

I still love laughing at the people who think the name on their diploma makes them a better physician or a smarter person. Watch out with your nose so much in the air. A small rainstorm may cause drowning.
Quite frankly I find people who succeed despite the name on their diploma, to be more interesting people and have more grit.
I also find it funny that people who come from “ivy league” programs useless in a community ed as they have no specialist to farm everything out to. When you have ortho do all your reductions, you’re cutting your legs from under yourself when you’re a solo doc in a community shop. Pun intended.

Apparently not. Must have been in the bottom 10th percentile of all hundred or so ER residencies.

Stupid me matched at a 4 yr one too.

I must be really f*ing dumb

 

[deleted206819]

That is a poo-flinging statement if there ever was one.

Did you work harder than me? I worked pretty damn hard to get into an Ivy League residency. I think I worked as hard as you, perhaps harder.

This wasn’t meant to be poo slinging but rather my perspective of getting into residency from a Caribbean school. The amount of hours doing research while preparing for the USMLEs was significant.

This isn’t to denigrate American grads and if I came across in that way then I apologize.

 

[Franzd'Epinay]

I've got unfortunate news for all you hardest-working tough guys:

 

[EMhawkeye]

Whenever someone brags about the name on their resume, I just think about that scene in patch adams between Robin Williams and Phillip Seymour Hoffman.
People who fetishize a big name, ridiculous board score etc like it makes any difference in the quality of physician that comes out in the end.
The powerhouse residency guy and those types are cut from the same obnoxious cloth.

 

[Franzd'Epinay]

Although I think there's one thing we can all agree on:

 

[Kryptocoin]

I think EM is a failed paradigm. Main reason is usage of the ER is almost never for emergencies. And that behavior is desired and accepted. Hospitals and our health care ethos have let that happen.

Me: Do you have a PCP?
Patient: No. Why do I need one when I can just come to the ER?

 

[thegenius]

Whenever someone brags about the name on their resume, I just think about that scene in patch adams between Robin Williams and Phillip Seymour Hoffman.
People who fetishize a big name, ridiculous board score etc like it makes any difference in the quality of physician that comes out in the end.
The powerhouse residency guy and those types are cut from the same obnoxious cloth.

Yea but you didn't graduate from an IVY LEAGUE residency.

 

[thegenius]

Me: Do you have a PCP?
Patient: No. Why do I need one when I can just come to the ER?

Yup them's the truth.

 

[EMhawkeye]

Yea but you didn't graduate from an IVY LEAGUE residency.

quod erat demonstrandum
Thank you for proving my point for me.
Please tell us more of the secrets you learned they only teach there that us poor mortals aren’t privy to. Cool story bro.

 

[VA Hopeful Dr]

quod erat demonstrandum
Thank you for proving my point for me.
Please tell us more of the secrets you learned they only teach there that us poor mortals aren’t privy to. Cool story bro.

Sarcasm can be a tricky thing over the internet...

 

[GonnaBeADoc2222]

Although I think there's one thing we can all agree on:

View attachment 360528

This is fantastic

 

[ScepticSkeksis]

How about Envision + HCA programs?

 

[Brigade4Radiant]

I don’t see the point about EM complaining about lower quality applicants. The Ivy League programs and a lot of Cali programs are 4 years. EM is a low quality specialty now.

Medicine is also highly standardized so it’s not like research. EMdocs Facebook group has more discussion on rashes than emergency conditions.

EM isn’t really respected in academics either compared to surgery or IM

 

[Arcan57]

I don’t see the point about EM complaining about lower quality applicants. The Ivy League programs and a lot of Cali programs are 4 years. EM is a low quality specialty now.

Medicine is also highly standardized so it’s not like research. EMdocs Facebook group has more discussion on rashes than emergency conditions.

EM isn’t really respected in academics either compared to surgery or IM

Are you ok?

 

[Rekt]

Are you ok?

Hes only wrong in the sense that he thinks it's a low quality specialty now. It always has been. No one goes into EM thinking they're going to get a bunch of respect or be some academic king. Or at least I really hope not because that would be incredibly dumb.

We do it because we get high pay (for now) and are in the hospital less than everyone else (for now). IM and surgery can think I'm a dummy even though there's a very high chance my board scores were higher than theirs anyway, but I'll wave to them on my way out the door without call to my five days off.

 

[RustedFox]

Hes only wrong in the sense that he thinks it's a low quality specialty now. It always has been. No one goes into EM thinking they're going to get a bunch of respect or be some academic king. Or at least I really hope not because that would be incredibly dumb.

We do it because we get high pay (for now) and are in the hospital less than everyone else. IM and surgery can think I'm a dummy even though there's a very high chance my board scores were higher than theirs anyway, but I'll wave to them on my way out the door without call to my five days off.

Day 1 of 7 off.
Just woke up after nightshift.
Playing Pikmin 3.
Eating cookies.
May not put on pants.

 

[EMhawkeye]

I don’t see the point about EM complaining about lower quality applicants. The Ivy League programs and a lot of Cali programs are 4 years. EM is a low quality specialty now.

Medicine is also highly standardized so it’s not like research. EMdocs Facebook group has more discussion on rashes than emergency conditions.

EM isn’t really respected in academics either compared to surgery or IM

Cool story bro. Tell it again

 

[sylvanthus]

Day 1 of 7 off.
Just woke up after nightshift.
Playing Pikmin 3.
Eating cookies.
May not put on pants.

Play elden ring man. Get with the in crowd.

 

[RustedFox]

Play elden ring man. Get with the in crowd.

I can't. I can't do the third-person/freeroaming/3D genre. I never have liked it; even since Super Mario 64.

I want 2D platformers (Metroidvanias) or isometric top-down 3D stuff (Bastion, Solstice, et.al).... OR a turn-based RPG.

This "the camera is above and slightly behind you and may not show what you need to see and may or may not need to be moved manually" thing is not for me. Let me enjoy the game, not spend half of my already limited attention span trying to correct the view.

Eff this "Kingdom Hearts" nonsense.

 

[BoardingDoc]

I can't. I can't do the third-person/freeroaming/3D genre. I never have liked it; even since Super Mario 64.

I want 2D platformers (Metroidvanias) or isometric top-down 3D stuff (Bastion, Solstice, et.al).... OR a turn-based RPG.

This "the camera is above and slightly behind you and may not show what you need to see and may or may not need to be moved manually" thing is not for me. Let me enjoy the game, not spend half of my already limited attention span trying to correct the view.

Eff this "Kingdom Hearts" nonsense.

This would seem to indicate that you were the correct age (much as I was) to play Zelda: ocarina of time on the N64 and have it completely and utterly rewrite your world view of video games (and simultaneously take a break to play Goldeneye and yell at your friends for screenlooking and/or playing as oddjob).... and yet you did not enjoy this experience?

Does not compute.