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I recall asking my Division Chief about why we didn't do any fast track/UC time (after I told her Mt Sinai did that - don't know if they still do). What she said was, "We train you for the major leagues - why would we send you down to double A?"
That wasn't a request. Please don't cross the line because I don't want to start giving post holds or banning anyone. Thank you.
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Bittersteel
Full Member
Man when some people get a little power lollll
Seriously
They should just be grateful the last batch of us doesn't jump ship to reddit. Site is already past its heyday by far (and frankly kept afloat by the stock thread, without which I probably wouldn't come here either) and further antagonistic behavior towards legitimate concerns of program expansion eroding the specialty further shouldn't have a snobbish response.
I would imagine--or hope--banning users requires admin approval at this point since there are so few users left that kicking people off is a self inflicted wound.
If you need to petulantly flaunt your powers of banning users as a grown man during legitimate discourse it's probably time to step away from the site yourself, @southerndoc
Unless you're intimidated enough by having this publicly pointed out to your face and you decide to ban me in your childish power trip--go for it
Banning requires several infractions. Just trying to keep the personal insults to a minimum. Not sure what Reddit requires for mods, but if that's where you need to go to mudsling then feel free to do your mudslinging there. Say all you want about me. I really don't care how much mudslinging you do toward me. The other users deserve better though -- including yourself. If someone was speaking harshly about you, I would also do the same.
Bittersteel
Full Member
You were the kid who reminded the teacher they forgot to assign homework huh?
LaheyClinicEM
New Member
Thank you all for your questions and concerns. I’m not a regular poster on Student Doctor Network, so I apologize for the delay in responding. The goal of my original post was simply to introduce our new program and let students know that we are recruiting our inaugural residency class.
To address some of the questions raised: We are a hospital-owned, Level I Trauma Center just outside of Boston. We have an incredibly engaged and collegial group of emergency physicians, including nationally recognized leaders in emergency medicine, with a robust academic and research infrastructure supported by millions of dollars in federal and industry-sponsored research funding. Our residents will have no shortage of high-acuity patients, procedures, or opportunities for hands-on training.
We have also intentionally partnered with neighboring institutions to ensure our residents receive a comprehensive clinical education across different practice environments. Our curriculum was designed around the newest ACGME requirements, but we also spent a great deal of time reflecting on our own residency experiences—what worked well, what we wished we had more exposure to, and what we believe physicians need to succeed in the changing landscape of emergency medicine.
Our goal is to train outstanding emergency physicians and future leaders who are equally comfortable practicing in a major academic medical center or a critical-access/community emergency department.
I completely understand that joining an inaugural residency class isn’t for everyone, and everyone should draw their own conclusions about what program is the right fit for them. That said, I encourage interested fourth-year medical students to apply, meet our faculty, ask us the difficult questions, and learn more about what we are building.
I think you may be pleasantly surprised by what this new residency has to offer
To address some of the questions raised: We are a hospital-owned, Level I Trauma Center just outside of Boston. We have an incredibly engaged and collegial group of emergency physicians, including nationally recognized leaders in emergency medicine, with a robust academic and research infrastructure supported by millions of dollars in federal and industry-sponsored research funding. Our residents will have no shortage of high-acuity patients, procedures, or opportunities for hands-on training.
We have also intentionally partnered with neighboring institutions to ensure our residents receive a comprehensive clinical education across different practice environments. Our curriculum was designed around the newest ACGME requirements, but we also spent a great deal of time reflecting on our own residency experiences—what worked well, what we wished we had more exposure to, and what we believe physicians need to succeed in the changing landscape of emergency medicine.
Our goal is to train outstanding emergency physicians and future leaders who are equally comfortable practicing in a major academic medical center or a critical-access/community emergency department.
I completely understand that joining an inaugural residency class isn’t for everyone, and everyone should draw their own conclusions about what program is the right fit for them. That said, I encourage interested fourth-year medical students to apply, meet our faculty, ask us the difficult questions, and learn more about what we are building.
I think you may be pleasantly surprised by what this new residency has to offer
Appreciate you actually coming back to this thread. I do have a follow up question:
What motivates you to contribute to the downfall of this specialty by opening up a new program in the face of significant surplus, when you could just as easily NOT while falling back on a $400k/yr clinical job?
LaheyClinicEM
New Member
That's a fair concern for the field broadly, but not one I'm going to hash out on this thread. We are a clinical shop with a lot to offer and have the right intentions. Happy to answer questions on our residency, but in the future will not be addressing non-Lahey related questions
That’s a question specifically directed at the new residency. Typical non-answer. You’ll have a bright administrative future with those kinds of non-answers/avoidance.
Why do I feel like this is an AI-generated response? It literally addressed none of the concerns brought up earlier in the thread, lol, but can't say I'm surprised.
Careful. Your difficult questions may be interpreted by admin as ‘not being cordial’
Bittersteel
Full Member
Because hospital admin told the EM department to start a residency so they can avoid hiring a few new attendings.
Bittersteel
Full Member
Because it's an AI generated residency.
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All y'all are getting the mod position statement wrong. Don't be passive/aggressive and think you're some angel or arbiter of common sense. And, as to Reddit, from what I've seen, they (subreddit mods) hold to their rules assiduously. You don't get banned for disagreement - you get banned for not adhering to the stated rules. If your snark is aimed at one person, and nasty, you're in the wrong. Refer to the rules of this website. Be nice. A question is fine. If you wrap it in an insult, you're wrong. And, sarcasm is difficult to transmit online; moreover, virtually all sarcasm is mean. You're not Hemingway. You can't thread that needle.
Yeah the whole situation is so unfortunate and I feel terrible for all the medical students who live in Massachusetts.
They clearly don't care about the quality of training or even training physicians for underserved areas that lack docs.
I mean they're not even pretending to care and recruited zero experienced faculty to run the residency program.
They were instructed to start the program and chose to do it because they didn't want to lose their jobs.
To be fair its not like this person is the one controllig it. These decisions come from way higher than some doc who works clinical shifts. You could argue why the OP would choose to do the admin job. But reality is if not them then it would be someone else. Its a pretty cush gig. Same pay (or maybe a little more or less) for much less work. who isnt on board for that? Getting some salary to sit through some meetings, maybe conference etc. Why not easier and a better life than the saturday overnight.
I am a major fatalist as to the future of EM. I have tried and occassionally succeeded in getting my former scribes to choose fields other than EM. Also with my current group we have been asked to expand / start 2 new EM residencies but we luckily have been able to convince admin to not do this.
The short term view is this is great for me and who cares if i pull up the ladder behind me.
Every PD with a program will come here and promise the world how they are great and will be amazing and special. In the end, the job is the job, I would be incredibly wary as a student in a dying and increasingly less competitive specialty to go to a new program. If you are a US grad with semi decent scores you can go to an established program without much effort.
That being said @JacobMcCandles the OP is simply filling a role and recruiting to make their lives during the match and post match as easy as possible. EM is screwed. I said from before, it will be local but in the end we are very close to the filling point of EM. It is near impossible to get a job in a "big name" city outside of absolute dumpster fire departments. Many of the new grads are woefully unprepared for community medicine as they spend way too much time on Social medicine and not enough learning how to manage an ED, move the meat and avoid looking for zebras at every corner. They lack the intuition a good EM doc tends to have.
If only EM were like anesthesia and a residency wasn't just easy labor
You’re right in that she isn’t the one who gave the final say so on starting a residency, however, she took the job and now she’s the face of the residency. It reminds me of the communications guy for Iraq way back when. The bottom line is that she took the job and she has a very active hand in the proliferation of unneeded residency spots. With the territory comes the heat from the questions. Her job is pretty easy on the surface because she doesn’t have to actually answer the questions. She doesn’t even have to respond and I’d guess we don’t see a whole lot more of her in the future. But, she does have to live with her own conscious and she’s read these comments and I bet they stick with her.
2 potential mitigating factors, albeit the full impact is yet to be determined.
Fairly high burnout/turnover rate. Yes, doesn't reflect well on our specialty as a whole.
Recent clampdown on H1B's and international students, which will drop foreign grad applicants. This could change with another government.
That will still leave plenty of DO schools, US-IMG/Caribbean grads as potential applicant pools. I don't know how popular EM is with those schools anymore. I graduated from an osteopathic school in the heyday of EM, where everyone and their grandmother was applying to EM programs. I've been looking at the class match lists as of late; this is clearly not the case anymore, with fewer grads going into EM.
Bittersteel
Full Member
Anesthesia would have gone the same way if not for covid. Their boomer docs rightly said "F this" and retired. As a young specialty, we didn't have a lot of old docs to off load.
Bittersteel
Full Member
New Rule: If you can't support all of your core EM experiences in house, including Trauma and Pediatrics and OB, you shouldn't have an EM residency.
It really is to easy for any ED to just start a residency which makes quality so variable.
That is exactly how HCA anesthesia residencies are. Cheap labor, crap education.
And, I have personally seen the discussions where a hospital is trying to push for increasing residency program size so that they can run more ORs for longer without hiring/paying additional CRNAs. Thankfully the PD shut that down.
I've already posted about the poor quality of new residencies but here's the perfect example from the new kaiser residency program:
Their first class of residents had so little exposure to sick patients on their shifts the admin had to create an R Pod (ESI 1-3 for residents).
Despite this when they looked at the numbers they had still only seen about 60 resus cases (ESI 1) after the pod was implemented.
If you do the math and you divide the number between the residents that is about 3 resus cases per year in their emergency department.
TAKE A MOMENT AND LET THAT SINK IN FOR A SECOND - THE EMERGENCY RESIDENTS AVERAGE 3 REAL EMERGENCIES EACH YEAR
The article from SAEM with all of the included statistics from the last year at the meeting: Resident Pod For New Residencies
Their first class of residents had so little exposure to sick patients on their shifts the admin had to create an R Pod (ESI 1-3 for residents).
Despite this when they looked at the numbers they had still only seen about 60 resus cases (ESI 1) after the pod was implemented.
If you do the math and you divide the number between the residents that is about 3 resus cases per year in their emergency department.
TAKE A MOMENT AND LET THAT SINK IN FOR A SECOND - THE EMERGENCY RESIDENTS AVERAGE 3 REAL EMERGENCIES EACH YEAR
The article from SAEM with all of the included statistics from the last year at the meeting: Resident Pod For New Residencies
If I'm not mistaken, there isn't much requirement to open it... they almost always approve every application and then cite the deficiencies a year or two later. There are many questionable programs for sure. A facility with 15,000 visits annually isn't a proper place to train.
I would note lots of places separate PEDs to different hospitals, which may be different systems / med schools / etc.
You need a solid solution to pedal volume, but it could be in a different campus…
All this reminds me that NPs get their training by having to find their preceptorships *on their own*
Bittersteel
Full Member
The thing is these barely passing USMLE bottom of the barrel candidates can match all they want at inferior programs such as the one run by @LaheyClinicEM...they have no shot at jobs such as at my SDG.
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None at mine either. How’s that for an advertisement?
Obviously I don’t know EM, so out of curiosity, it looks like the Lahey sites are under 6 pph total (50k/365/24). How many attendings and residents would it realistically take to staff those 3 EDs?
Depends many different factors.
Lots of community hospitals basically average 2-4 PPH for docs + residents/midlevels so could be as little as 4-8 docs + 4-8 residents/midlevels per day.
Assume each one covers 120 hours each month and its 12 docs + 12 residents/midlevels bare minimum.
Yeah its common but still terrible for PEM training in residency.
Lots of reasons but in essence:
1. The PEDs will often be reluctant to let unknown residents from outside institutions see the sick patients and do the procedures.
2. The PEDs will often already be completely flooded with other learners to include other residency programs.
3. The PEDs will often function largely as triage services and let consultants manage the patients.
ABEM says 4% of pt encounters have to be peds. That's either in the general ED, or dedicated PED.
so what is your solution?
In Boston only Boston Medical Center has a true level 1 ED and sees true pediatric volume (they have peds residents, and a pedi ED).
MGH? BWH? BIDMC? All adult only and partner with Boston Children’s (peds only…) for training.
As well, they all gather larger community hospitals with pedi-EDs or large pedi populations to achieve a level of training different from a quarterly care pedi Mecca.
I found this training did me well, outsourcing peds to dedicated centers in regions of the country where most peds volume is shunted to said centers is reasonable…
In Boston only Boston Medical Center has a true level 1 ED and sees true pediatric volume (they have peds residents, and a pedi ED).
MGH? BWH? BIDMC? All adult only and partner with Boston Children’s (peds only…) for training.
As well, they all gather larger community hospitals with pedi-EDs or large pedi populations to achieve a level of training different from a quarterly care pedi Mecca.
I found this training did me well, outsourcing peds to dedicated centers in regions of the country where most peds volume is shunted to said centers is reasonable…
I agree. My point though is if not her then there is another one. That’s reality. It’s like the bozos who serve as the “contract holders” in the CMGs. Just puppets and they are complicit and throwing smoke their way and holding their feet to the fire is reasonable. It wont change much and will make us feel better but in the end there is another clown in line somewhere.
I told my partners I will never have an HCA residency grad as my partner. We mistakenly hired a guy from a no name residency. Was atrocious. We are a super nice group and don’t like to hurt feelings but we had to let this fella go.
Well first of all I'd close all these new residencies so there aren't 6 residencies for every single peds hospital.
Beyond that I've always told admin they should mandate away rotations where there are still tons of sick kids aka outside the United States.
Most established programs already have Global Health tracks with affiliations for rotations and you can easily see 10x the number of sick kids in one month in countries like Kenya or Mozambique with no vaccinations and lots of infectious disease. The big problem of course is that it would be a lot more work and would cost a lot more and no one wants to pay for anything even the ivy league residency programs with millions of dollars.
(I say this having worked in Global Health with both Harvard and Partners in Health)
I honestly wouldn't hire anyone who comes from any program that started over the past 10 years.
Lurking here, psychiatrist. We have the same problem, big time. It's very financially rewarding for admins to open up shoddy residencies and graduate psychiatrists that barely know how to write a psychiatric formulation. Every year new residencies pop up, and they're often massive, 10+ resident programs. I guess it's encouraging that EM docs see the problem and are at least annoyed by it? Psychiatry is such a siloed world, we have minimal outrage other than the "doomers" online (and those people get trashed for being doomers).
Are there any collective efforts to stop the supply problem in medicine? EM and psych are going hand in hand into the oversupply abyss it seems like.
Emergency Medicine Residency Program | Cleveland Clinic
Learn more about Cleveland Clinic Emergency Department's residency program.
my.clevelandclinic.org
Cleveland clinic is opening up a new EM residency next death spiral is accelerating
That's shocking
They were unabashedly anti-EM when I was applying years ago
Apparently the prestigious clinic just wants chart monkeys to admit to the medicine gods that roam those floors....it was built to not have trauma (beneath them) or teach in the ed (all teaching for Uber specialty services)
Must be having money problems, prestige doesn't pay bills. Bring on the slave labor!
They were unabashedly anti-EM when I was applying years ago
Apparently the prestigious clinic just wants chart monkeys to admit to the medicine gods that roam those floors....it was built to not have trauma (beneath them) or teach in the ed (all teaching for Uber specialty services)
Must be having money problems, prestige doesn't pay bills. Bring on the slave labor!
Not really. As you’ve seen in this thread, PDs think their residency is deserved and not part of the problem.
