Residency Programs: Announcements and Advertisements

[alpinism]

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So for those not aware of Insight Hospital here's an article from last month about their emergency department:

The Ambulance Chasers of Totaled Hospitals - The American Prospect

Insight Health is the pride of Flint, Michigan, and it’s coming for a failing hospital near you.

prospect.org

Some of the many highlights:

-Hospital run by a pain doctor with zero management experience who is accused of millions in medicare fraud in multiple states
-Bought the hospital for one dollar after bankruptcy and proceeded to fire most of the staff and replace with other pain doctors
-Runs a pain clinic out of the hospital that has been accused of falsifying diagnoses and performing uneccesary procedures
-Sends pain docs over to the ED to basically pick up any patients with chronic pain and then admit them to the hospital
-Mandates pain docs use the ED to perform procedures to circumvent insurance authorizations needed for payment

Not to mention the hospital apparently isn't paying any of their bills for supplies and so lacks basic supplies such as curtains and wheelchairs and suffers from out of service water filters and air conditioners but has refused to fix any of the problems because its not in the hospital budget.

 

[alpinism]

I’ll add that it appears the new PD has literally no prior aPD or even non aPD core faculty experience and has only been an attending for 5 years.

She was however just appointed to be the new chair of EM at WAUSOM which as far as I can tell looks like a brand new corporate run for profit Caribbean Medical School in the Bahamas that has been denied US accreditation and so its students are not eligible to do a US residency.

 

[alpinism]

I have no idea how the ACGME gave them approval to start this residency program.

 

[JacobMcCandles]

So for those not aware of Insight Hospital here's an article from last month about their emergency department:

The Ambulance Chasers of Totaled Hospitals - The American Prospect

Insight Health is the pride of Flint, Michigan, and it’s coming for a failing hospital near you.

prospect.org

Some of the many highlights:

-Hospital run by a pain doctor with zero management experience who is accused of millions in medicare fraud in multiple states
-Bought the hospital for one dollar after bankruptcy and proceeded to fire most of the staff and replace with other pain doctors
-Runs a pain clinic out of the hospital that has been accused of falsifying diagnoses and performing uneccesary procedures
-Sends pain docs over to the ED to basically pick up any patients with chronic pain and then admit them to the hospital
-Mandates pain docs use the ED to perform procedures to circumvent insurance authorizations needed for payment

Not to mention the hospital apparently isn't paying any of their bills for supplies and so lacks basic supplies such as curtains and wheelchairs and suffers from out of service water filters and air conditioners but has refused to fix any of the problems because its not in the hospital budget.

I look forward to Anita, Julia, and Suzanne’s response.

 

[tampaEMdoc]

Hello SDN,

I would like to let you know about a new ACGME accredited residency program in Tampa, FL at AdventHealth Tampa. We are currently accepting applications for July 2026 start. See below for details. We are excited about building a great educational experience!

Emergency Medicine Residency at AdventHealth Tampa

The AdventHealth Emergency Medicine Residency at AdventHealth Tampa serves Tampa's busiest emergency department, with a census of over 90,000.

www.adventhealth.com

 

[xaelia]

EM training spots have doubled since 2010.

Absolutely shooting ourselves in the foot (or, more likely, a more critical organ).

 

[tampaEMdoc]

EM training spots have doubled since 2010.

Absolutely shooting ourselves in the foot (or, more likely, a more critical organ).

I know this has been a concern, however I think that our faculty and leadership are all in it for the right reasons. We have planned the program around the new proposed ACGME requirements which are more stringent. Other programs may have trouble, but I think we are building a robust training curriculum that will deliver an excellent experience for our future colleagues!

 

[JacobMcCandles]

I know this has been a concern, however I think that our faculty and leadership are all in it for the right reasons. We have planned the program around the new proposed ACGME requirements which are more stringent. Other programs may have trouble, but I think we are building a robust training curriculum that will deliver an excellent experience for our future colleagues!

I mean, would you expect a PD to say “hey, I know our program is going to suck but it’s cheap labor.”?

The right reasons would be to stop the proliferation of EM residencies.

Also, who staffs the ED (SDG, CMG, hospital employed, etc.)?

 

[TooMuchResearch]

EM training spots have doubled since 2010.

Absolutely shooting ourselves in the foot (or, more likely, a more critical organ).

The skin. You have two feet but only one skin.

 

[xaelia]

I mean, would you expect a PD to say “hey, I know our program is going to suck but it’s cheap labor.”?

AdventHealth Orlando boasts a ABEM written pass rate <80% since 2017.

Great track record, team.

 

[AlmostAnMD]

our faculty and leadership are all in it for the right reasons.

Cheap labor

Fire expensive midlevels

Attendings do less work

Further saturate the EM milieu in general and florida specifically and drive down competitive salaries for attendings across the country

I think I hit most of them?

Also you definitely posted this to the wrong site, which you probably already figured out

 

[EctopicFetus]

I know this has been a concern, however I think that our faculty and leadership are all in it for the right reasons. We have planned the program around the new proposed ACGME requirements which are more stringent. Other programs may have trouble, but I think we are building a robust training curriculum that will deliver an excellent experience for our future colleagues!

Even if the program is good, understand it is not needed. and even if the other programs suck it doesnt deflect from the lack of need. That being said I am sure it wasnt your decision to start it so you are doing what yuo can. Similarly, you are in a great location but none of that matters imo cause its something we dont need.

But whatever. Florida is insanely overrun with programs.

 

[EctopicFetus]

AdventHealth Orlando boasts a ABEM written pass rate <80% since 2017.

Great track record, team.

Isnt that USUCKS? If so makes complete sense..

 

[Janders]

I grew up in FL and did school in FL. When I looked at residencies there were only a handful (Shands Jax, UF was a 1st year program in Gville, USF Tampa was young, UCF Orlando was in its 2nd year IIRC...). How many do we have now?

 

[docmcmanus]

I mean, would you expect a PD to say “hey, I know our program is going to suck but it’s cheap labor.”?

The right reasons would be to stop the proliferation of EM residencies.

Also, who staffs the ED (SDG, CMG, hospital employed, etc.)?

Well - I am the program director with 30 years of academic, community and military experience and agree with most of the concerns and comments. Just because we have many programs that may not be meeting the academic or ACGME standards, that is a true concern, but not a reason to not have excellent programs formed. I have worked in academic and community programs and there are great community programs and there are terrible academic programs. I can assure you we did not apply for a GME program to make money at AdventHealth. We recruited many academic faculty to our practice because the hospital and system is exactly the system you will be working in when you graduate. The best judge of programs are the graduates and current residents of your program(s) of interest. I would caution any blanket opinions on the internet who haven’t actually worked in facilities they are criticizing. We would love to answer any questions and mentor anyone in their emergency medicine career, regardless of where they desire to train. I am happy to help any future emergency medical clinician/ leader along their professional path. Anyone can call or text me anytime to discuss. Col(ret) John McManus MD MBA MCR FACEP FSEM FAAEM / 210-240-6995

 

[Porfirio]

Well - I am the program director with 30 years of [experience]

Why would you go along with and enable this? You see/seen the destruction it has caused to our field to have such explosive, relentless expansion.

Cheers to your 30 years, hopefully I can get at least 10-15 good years. Good luck after that.

 

[JacobMcCandles]

Well - I am the program director with 30 years of academic, community and military experience and agree with most of the concerns and comments. Just because we have many programs that may not be meeting the academic or ACGME standards, that is a true concern, but not a reason to not have excellent programs formed. I have worked in academic and community programs and there are great community programs and there are terrible academic programs. I can assure you we did not apply for a GME program to make money at AdventHealth. We recruited many academic faculty to our practice because the hospital and system is exactly the system you will be working in when you graduate. The best judge of programs are the graduates and current residents of your program(s) of interest. I would caution any blanket opinions on the internet who haven’t actually worked in facilities they are criticizing. We would love to answer any questions and mentor anyone in their emergency medicine career, regardless of where they desire to train. I am happy to help any future emergency medical clinician/ leader along their professional path. Anyone can call or text me anytime to discuss. Col(ret) John McManus MD MBA MCR FACEP FSEM FAAEM / 210-240-6995

We’ll probably disagree all day about the number of good programs and if other programs, even if they turn out to be solid, are even needed.

How do you feel about the AdventHealth Florida EM residency?

Who is staffing the ED for this new program?

 

[southerndoc]

Hello SDN,

I would like to let you know about a new ACGME accredited residency program in Tampa, FL at AdventHealth Tampa. We are currently accepting applications for July 2026 start. See below for details. We are excited about building a great educational experience!

Emergency Medicine Residency at AdventHealth Tampa

The AdventHealth Emergency Medicine Residency at AdventHealth Tampa serves Tampa's busiest emergency department, with a census of over 90,000.

www.adventhealth.com

Merged thread into existing new residency announcement thread.

 

[alpinism]

I grew up in FL and did school in FL. When I looked at residencies there were only a handful (Shands Jax, UF was a 1st year program in Gville, USF Tampa was young, UCF Orlando was in its 2nd year IIRC...). How many do we have now?

I believe this is the 25th residency program.

 

[alpinism]

We’ll probably disagree all day about the number of good programs and if other programs, even if they turn out to be solid, are even needed.

How do you feel about the AdventHealth Florida EM residency?

Who is staffing the ED for this new program?

Take a wild guess who runs the program.

It’s a USACS site and they’re desperately
looking for cheap labor to help with paying
their millions in debt to private equity.

 

[JacobMcCandles]

Well - I am the program director with 30 years of academic, community and military experience and agree with most of the concerns and comments. Just because we have many programs that may not be meeting the academic or ACGME standards, that is a true concern, but not a reason to not have excellent programs formed. I have worked in academic and community programs and there are great community programs and there are terrible academic programs. I can assure you we did not apply for a GME program to make money at AdventHealth. We recruited many academic faculty to our practice because the hospital and system is exactly the system you will be working in when you graduate. The best judge of programs are the graduates and current residents of your program(s) of interest. I would caution any blanket opinions on the internet who haven’t actually worked in facilities they are criticizing. We would love to answer any questions and mentor anyone in their emergency medicine career, regardless of where they desire to train. I am happy to help any future emergency medical clinician/ leader along their professional path. Anyone can call or text me anytime to discuss. Col(ret) John McManus MD MBA MCR FACEP FSEM FAAEM / 210-240-6995

It's tough to reconcile what you said up there with who your employer is:

Emergency Medicine Physician | USACS

You got into medicine to do one thing: care for patients. You've come to the right place. Ours is a Physician-owned group, the largest in the nation, meaning we have built a model that allows our Physicians to focus on our mission: to care fo...

www.usacs.com

 

[southerndoc]

Well - I am the program director with 30 years of academic, community and military experience and agree with most of the concerns and comments. Just because we have many programs that may not be meeting the academic or ACGME standards, that is a true concern, but not a reason to not have excellent programs formed. I have worked in academic and community programs and there are great community programs and there are terrible academic programs. I can assure you we did not apply for a GME program to make money at AdventHealth. We recruited many academic faculty to our practice because the hospital and system is exactly the system you will be working in when you graduate. The best judge of programs are the graduates and current residents of your program(s) of interest. I would caution any blanket opinions on the internet who haven’t actually worked in facilities they are criticizing. We would love to answer any questions and mentor anyone in their emergency medicine career, regardless of where they desire to train. I am happy to help any future emergency medical clinician/ leader along their professional path. Anyone can call or text me anytime to discuss. Col(ret) John McManus MD MBA MCR FACEP FSEM FAAEM / 210-240-6995

Nice to see you on here. Didn't realize you went to head up the program there. Hopefully you're still staying on EMSMDAC. 🙂

 

[WhatJobDoIPick]

Well - I am the program director with 30 years of academic, community and military experience and agree with most of the concerns and comments. Just because we have many programs that may not be meeting the academic or ACGME standards, that is a true concern, but not a reason to not have excellent programs formed. I have worked in academic and community programs and there are great community programs and there are terrible academic programs. I can assure you we did not apply for a GME program to make money at AdventHealth. We recruited many academic faculty to our practice because the hospital and system is exactly the system you will be working in when you graduate. The best judge of programs are the graduates and current residents of your program(s) of interest. I would caution any blanket opinions on the internet who haven’t actually worked in facilities they are criticizing. We would love to answer any questions and mentor anyone in their emergency medicine career, regardless of where they desire to train. I am happy to help any future emergency medical clinician/ leader along their professional path. Anyone can call or text me anytime to discuss. Col(ret) John McManus MD MBA MCR FACEP FSEM FAAEM / 210-240-6995

Shame on you for destroying our field.

How much is Bagnoli paying you for this?

 

[DocEspana]

Even if the program is good, understand it is not needed. and even if the other programs suck it doesnt deflect from the lack of need. That being said I am sure it wasnt your decision to start it so you are doing what yuo can. Similarly, you are in a great location but none of that matters imo cause its something we dont need.

But whatever. Florida is insanely overrun with programs.

Its so funny that 10 years ago there were... what... two or three programs in the whole state? I think Jackson (university of miami) opened theirs 10 or 11 years ago and that was, iirc, #3 or 4 in the whole state. and then THE FLOODGATES OPENED right behind it.

There are 25 now. jeeeesus

 

[emergentmd]

A program that has to go on SDN to advertise their program are desperate for good residents. Prove me wrong. I read the residents background and I would say they are not coming from top notch medical school.

 

[Brigade4Radiant]

Does EM still do the SLOE thing? Also is EM a 4 year thing confirmed?

If that’s true FM would be more competitive than EM with FM you can do hospitalist rural EM clinic stuff and a shorter residency with less headache to go through as a med student

If I was a med student I would not even entertain the SLOE nonsense

 

[trackrunner321]

The destruction continues... Sad to see that "leaders" of our field are actively leading it to its downfall... No one cares how "good" the program will be. We need like negative 50 programs.

 

[HemorrhagicShock]

A program that has to go on SDN to advertise their program are desperate for good residents. Prove me wrong. I read the residents background and I would say they are not coming from top notch medical school.

You're kidding yourself if you think EM requires any kind of skill/connections/ability that are represented by a degree from and/or acquired at a "top notch" medical school.

It's a blue collar job that at best requires an average IQ to perform at the level required by the US medical system in 2025. It's far more about discipline and ability to eat **** from patients, admin, other physicians, and to smile while asking for more.

The difference between a "well-trained" ER doc and a "passable on a good day" ER doc can't be teased out by administrator-driven metrics. Of course you and I know the difference, it's obvious who has been trained well and who hasnt. But it doesn't matter one bit to the system as its currently set up.

The value of "top tier" EM training and paint-by-numbers high-volume CMG training is irrelevant for 98% of EM jobs out there.

 

[RustedFox]

Florida Man here.
USUCKS residency will graduate USUCKS residents. We fired two last year.

 

[EctopicFetus]

Many year ago, there were 4 residencies in Florida. Orlando Health (whatever it was called back then), Jacksonville (UF) and USF in Tampa. Maybe UF in Gainesville was #4.. i cant recall. Now tiny little turdlette hospitals with turd residencies abound. Sad state of affairs.

 

[WhatJobDoIPick]

You're kidding yourself if you think EM requires any kind of skill/connections/ability that are represented by a degree from and/or acquired at a "top notch" medical school.

It's a blue collar job that at best requires an average IQ to perform at the level required by the US medical system in 2025. It's far more about discipline and ability to eat **** from patients, admin, other physicians, and to smile while asking for more.

The difference between a "well-trained" ER doc and a "passable on a good day" ER doc can't be teased out by administrator-driven metrics. Of course you and I know the difference, it's obvious who has been trained well and who hasnt. But it doesn't matter one bit to the system as its currently set up.

The value of "top tier" EM training and paint-by-numbers high-volume CMG training is irrelevant for 98% of EM jobs out there.

It's pretty sad tbh. I had top usmle scores and went to a medical school and residency where EM was pretty respected, but now I'm equivalent to any schmuck who went to a bottom tier usacs or hca residency.

 

[EctopicFetus]

It's pretty sad tbh. I had top usmle scores and went to a medical school and residency where EM was pretty respected, but now I'm equivalent to any schmuck who went to a bottom tier usacs or hca residency.

This is incredibly true. Overseeing a bunch of docs i can tell you man there are some really dumb, lazy and weird EM docs. Some are very special snowflakes who dont want to see patients, some just want to sit to get paid, some want more acuity, some want less, some want PSLF, some want just high pay.

I guess im old school. I believe work hard and earn well. What’s sad is the complete and utter clowns who do our jobs. Im mid career where I remember the old guys were slow and sucked and stressed, Many didnt train in EM and effectively had on the job training and the world of EM changed underneath their feet. Strokes, sepsis, STEMI all that management changed and became very time sensitive.

I remember thinking man, eventually they will retire and things will be better. Now those guys/gals are gone they retired.. and i look at a subset (not all) of the new grads and I think to myself, holy cow.. its like the old guys from before. Many trained at CMG sites with no volume but they believe they are well trained which is even scarier. Many are on par with those who do the 1 yr FM/EM fellowship. Overconfident underperforming..

 

[Brigade4Radiant]

This is incredibly true. Overseeing a bunch of docs i can tell you man there are some really dumb, lazy and weird EM docs. Some are very special snowflakes who dont want to see patients, some just want to sit to get paid, some want more acuity, some want less, some want PSLF, some want just high pay.

I guess im old school. I believe work hard and earn well. What’s sad is the complete and utter clowns who do our jobs. Im mid career where I remember the old guys were slow and sucked and stressed, Many didnt train in EM and effectively had on the job training and the world of EM changed underneath their feet. Strokes, sepsis, STEMI all that management changed and became very time sensitive.

I remember thinking man, eventually they will retire and things will be better. Now those guys/gals are gone they retired.. and i look at a subset (not all) of the new grads and I think to myself, holy cow.. its like the old guys from before. Many trained at CMG sites with no volume but they believe they are well trained which is even scarier. Many are on par with those who do the 1 yr FM/EM fellowship. Overconfident underperforming..

They aren’t owners so why bother? If it’s hourly you would be a fool to see more patients than average or to shorten your length of stay.

We keep talking about how crappy of a field EM is but want top work for ever increasing loan burden and lack of respect if you are treated as easily replaceable let them fire you and work at the other hospital down the road. It not like they are getting anything unique

 

[HemorrhagicShock]

It's pretty sad tbh. I had top usmle scores and went to a medical school and residency where EM was pretty respected, but now I'm equivalent to any schmuck who went to a bottom tier usacs or hca residency.

This is what kills me the most about it. I had a pedigree that could have allowed me to apply derm, plastics, ortho, you name it. I had the scores and everything.

Yet I chose EM because I wanted to "help every walk of life that needed medical care"

It was a vague goal, made sense when I was young, and truth be told, still gives me a lot of meaning now that I"ve accomplished the goal and have the board cert. It's definitely a great feather in the cap.

But with the pedgree like ours, we'll always wonder "what if..."

 

[WhatJobDoIPick]

This is what kills me the most about it. I had a pedigree that could have allowed me to apply derm, plastics, ortho, you name it. I had the scores and everything.

Yet I chose EM because I wanted to "help every walk of life that needed medical care"

It was a vague goal, made sense when I was young, and truth be told, still gives me a lot of meaning now that I"ve accomplished the goal and have the board cert. It's definitely a great feather in the cap.

But with the pedgree like ours, we'll always wonder "what if..."

The plus side of EM is that when I semi retire in the next few years, I can still choose to work 5 days / month and make 200k. Hard to to that as a surgeon probably.

 

[emergentmd]

You guys who think this is only EM are out of touch. This reality of lowering work ethics is throughout all fields. Talk to most specialists and you will get the same.

I had lunch with old medical school friends this week who are now a hospitalist and pedi hospitalist at teaching hopsitals. The stuff they tell me is just sad.

Me - When I did residency, I never saw our attending in any service after about 10am. Round in the am, and unless someone is near death, never gets caled
Pedi Hospitalist - Residents call me all the time for the dumbest things. When I am working, I have to see/chart on all the patients. It is more work with residents than just doing it myself. When I am on overnight call, I get the dumbest nurses call like telling me that the pts labs are back. And if I don't respond nicely, they would chart that I did not take any actions on normal labs.
Hospitalist steps out of lunch to take a call - Sorry, I had to deal with working to get a pt discharged.
Me - WTF? Why are you dealing with discharging a patient when you have residents. Why are you taking calls that labs are back esp normal. Where are the residents to take these calls.
Me - Man, When I was on medicine month, my 2nd year and I (ER intern) was on VA call and pt was having a seizure that would not stop. 2nd year turns to me and asks what he should do. I was like, "You asking the wrong person bro". Him, Crap, then opens a book to figure things out.

No wonder new attendings suck. They get coddled all through residency and can't critically think when they get out.

Truthfully, I am glad I am essentially out of medicine. Still have my foot in as an owner so I kind of do whatever I want 99% of the time. Don't have to deal with whiny admin, whiny nurses, ignorant trainwreck medicare pts, demanding medicaid pts, crazy families. I take care of the 25% generally grateful people who know their medical history who tries to stay healthy.

If I had to go back to the ER, I would have completely retired

 

[bravotwozero]

No wonder new attendings suck. They get coddled all through residency and can't critically think when they get out.

One of the FSEDs I worked at admitted their patient to a major tertiary care center in town, that had a resident teaching service. In the morning, the team would start taking admissions, and after a few admits would be 'capped' by like 11am. After which I would send any subsequent admits to the private hospitalist, until the new resident team came on (at 7pm!). When I'd notify the reluctant private hospitalist that the resident teaching service team is 'capped', he'd dryly remark that he has a census of 35+ patients with 10 admits in the last hour lol.

So yup, coddled is definitely right.

 

[emergentmd]

One of the FSEDs I worked at admitted their patient to a major tertiary care center in town, that had a resident teaching service. In the morning, the team would start taking admissions, and after a few admits would be 'capped' by like 11am. After which I would send any subsequent admits to the private hospitalist, until the new resident team came on (at 7pm!). When I'd notify the reluctant private hospitalist that the resident teaching service team is 'capped', he'd dryly remark that he has a census of 35+ patients with 10 admits in the last hour lol.

So yup, coddled is definitely right.

Dude, so bad. Just so bad. Hour strictly capped. Admission capped. Call hours capped. Dedicated studying time. Seems like residency has become a cakewalk.

I remember when I was midway into my attending and had a new Hospitalist. He got killed which was par for the course. Called him for another admission, after apologizing b/c I knew his life sucked. Dude actually told me, "I am capped". Me, "Sorry but your it". Capped? hahahahaha

 

[WhatJobDoIPick]

One of the FSEDs I worked at admitted their patient to a major tertiary care center in town, that had a resident teaching service. In the morning, the team would start taking admissions, and after a few admits would be 'capped' by like 11am. After which I would send any subsequent admits to the private hospitalist, until the new resident team came on (at 7pm!). When I'd notify the reluctant private hospitalist that the resident teaching service team is 'capped', he'd dryly remark that he has a census of 35+ patients with 10 admits in the last hour lol.

So yup, coddled is definitely right.

Yup. I've worked in systems where is inpatient resident team (made up of idiots mind you) was "capped.". Funny, we don't get capped down in the ER.....

 

[xaelia]

Yup. I've worked in systems where is inpatient resident team (made up of idiots mind you) was "capped.". Funny, we don't get capped down in the ER.....

Yea, I don't think this is terribly uncommon to have an admission cap and/or census cap where extra admissions roll over to an admitting hospitalist and non-teaching service. Not that much different from surgery having a practical "cap" by bumping elective cases for urgent etc. due to limited OR space etc.

 

[WhatJobDoIPick]

Yea, I don't think this is terribly uncommon to have an admission cap and/or census cap where extra admissions roll over to an admitting hospitalist and non-teaching service. Not that much different from surgery having a practical "cap" by bumping elective cases for urgent etc. due to limited OR space etc.

Cool. I'd like a cap on septic patients and falling grandmas please.

 

[xaelia]

Cool. I'd like a cap on septic patients and falling grandmas please.

Interestingly, some EDs do "cap" – overseas ones with ambulance ramping are effectively capped because there's no more physical space to unload patients due to inpatient bed block.

 

[WhatJobDoIPick]

Interestingly, some EDs do "cap" – overseas ones with ambulance ramping are effectively capped because there's no more physical space to unload patients due to inpatient bed block.

Ah see in america we just line the hallways then yell at the doctors for not seeing 4 pph.

 

[AlmostAnMD]

Taking an opposite point, I'm fine with hospitalist caps.

I say that as an ex-EM doc (drowning in previous life) that now works on hospital admin side

We all know it's easy to just shove through the doors anything upstairs and not even think about it

But once they are admitted they need

1) a plan for their hospital course
2) not to have anything missed, related to point 1 really

So I'd rather they take their time and interview grandma for 90 minutes and to do that effectively we need caps

We still flex up occasionally on the caps in our tertiary facilities, it's not a literal law, but a reasonable safety principle

Sadly the ed does end up the lowest priority for reasons still vexing to me but probably relate to payment/inertia

 

[WhatJobDoIPick]

Taking an opposite point, I'm fine with hospitalist caps.

I say that as an ex-EM doc (drowning in previous life) that now works on hospital admin side

We all know it's easy to just shove through the doors anything upstairs and not even think about it

But once they are admitted they need

1) a plan for their hospital course
2) not to have anything missed, related to point 1 really

So I'd rather they take their time and interview grandma for 90 minutes and to do that effectively we need caps

We still flex up occasionally on the caps in our tertiary facilities, it's not a literal law, but a reasonable safety principle

Sadly the ed does end up the lowest priority for reasons still vexing to me but probably relate to payment/inertia

I'm guessing your ERs aren't staffed by an SDG or anyone that cares about throughput?

 

[bravotwozero]

Well there is this thing called EMTALA that's going to make 'caps' in ED impossible, closest you can come is diversion. Hospitalists can do that because they have the ED as a buffer between them and patients.

 

[AlmostAnMD]

I'm guessing your ERs aren't staffed by an SDG or anyone that cares about throughput?

It's somewhat counterintuitive but if hospitalists dont have clear, clean succinct plans and estimated discharge days it backs up hospital worse! ED patients won't have any place to go! I know this as one of a few people in charge of throughput.

Our average obs time is 23 hours (admitted patients) for a tertiary facility thats p good

 

[Pinner Doc]

This is what kills me the most about it. I had a pedigree that could have allowed me to apply derm, plastics, ortho, you name it. I had the scores and everything.

Yet I chose EM because I wanted to "help every walk of life that needed medical care"

It was a vague goal, made sense when I was young, and truth be told, still gives me a lot of meaning now that I"ve accomplished the goal and have the board cert. It's definitely a great feather in the cap.

But with the pedgree like ours, we'll always wonder "what if..."

Same. But none of that interested me! The only thing that sort of turned my head was anesthesia, but half my med school class was applying. It felt over saturated at the time, or at least at my institution.

 

[WhatJobDoIPick]

Same. But none of that interested me! The only thing that sort of turned my head was anesthesia, but half my med school class was applying. It felt over saturated at the time, or at least at my institution.

Agree. Anesthesia felt like it was on the hard decline when I was applying. EM was the sexy newly competitive specialty. The. COVID hit and all the old gas docs were like "deuces!!" And their market exploded. Meanwhile EM docs became simps and fooked themselves.

 

[AlmostAnMD]

Meanwhile EM docs became simps and fooked themselves.

Completely true and self-inflicted wound. Look back at this forum 10 years ago. Filled with "I can just clock in/clock out", "work wherever I want", "i just see patients and don't worry about meetings or education"

What that attitude actually translates to is, "we don't want a seat at the decision making table" and while docs are just clocking in and out major policy shifts were happening, leaving Ed docs on an island no one cares about and is slowly sinking.

In this respect, nurses had a better play than docs, but they had a better incentive. An ed nurse makes pennies compared to ed docs (exaggerating). Thus, ed docs were not incentivized to go an administrative route since that would definitely decrease or laterally move pay.

For nurses it significantly increased their revenue stream. Nursing directors/administrators make significantly more than floor nurses AND influence policy.

A few decades of this, and you'll see why every administrative position in a hospital is a nurse with a few docs peppered in.

Thus, even the nursing lobbying on a national level is infinitely more organized and effective than dickless cmg shells like ACEP.

This is one of a myriad of reasons I left clinical practice. I enjoy working on the policy side, prioritizing revenue increases to hospital and applying pressure to insurance companies. I'm trying to streamline things for floor docs so they can get paid more and do less work with fewer epic workflow stops.