Dec 17, 2018
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I came across this piece of legislation and was wondering what everyone's thoughts were over here in EM: AAMC Statement on Introduction of Senate GME Expansion Legislation

Even though it seems to have the support of many physicians wouldn't the creation of 15,000 more residency spot (about a 50% increase in what we have in the US today) create a glut of residents (I believe it's only about 2500 MD/DOs that go unmatched every year) and make finding a job very difficult/lower wages across the board? Aren't we already complaining about all the new EM residency programs cropping up?
 

GonnaBeADoc2222

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I came across this piece of legislation and was wondering what everyone's thoughts were over here in EM: AAMC Statement on Introduction of Senate GME Expansion Legislation

Even though it seems to have the support of many physicians wouldn't the creation of 15,000 more residency spot (about a 50% increase in what we have in the US today) create a glut of residents (I believe it's only about 2500 MD/DOs that go unmatched every year) and make finding a job very difficult/lower wages across the board? Aren't we already complaining about all the new EM residency programs cropping up?
Tell them to get higher USMLE scores.
 

enalli

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I'm of the opinion that one gets to complain either about mid-level encroachment or about physician oversupply, but not both. I believe the former is the real threat to our profession.
 
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gamerEMdoc

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I think the intent is to get many of the residency spots that are unfunded to be funded spots. 1/3 of our current spots come with no funding in my program because the hospital was over its GME cap. This cap was set long before we even had an EM residency, and to create the residency back in the day, we had to take spots from other programs at the hospital. It would be very helpful to have all of the spots in programs already in existence actually get funding for their accredited spots, not just for EM, but all programs.
 
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The Knife & Gun Club

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I would love to see this with some sort of effect on what kind of residencies are getting funded too.

We’ve got enough EM residencies for one lifetime, but there’s some (primary care) fields that could sorely use more docs.
 
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Brigade4Radiant

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Only if ACGME has stricter standards for residencies to ensure quality. I mean seriously these CMG are opening residencies at places that shouldn't have them. I mean places with no trauma or OB are getting residencies where you practice metric driven medicine and most of the docs on staff are locums.
 
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thegenius

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There is a physician shortage in this country and we need more doctors. But it's not equally spread out among all specialties (IM, EM, Cardiology, etc.). We have an absolute dearth of primary care providers due to a variety of reasons, and we have a dearth of doctors in low-income and rural areas.

Until someone comes up with a plan to address massive wage disparity and lack of interest to live in a undesirable areas...we will not make significant progress by just adding more residency spots.

There needs to be a tighter distribution for wages among doctors. The docs making 750K - 1M need to come down some. And those making 125K need to make more.

This is why people can never see their primary docs on a timely basis. They are squeezed for time and there aren't enough of them.
 
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Rekt

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I'm of the opinion that one gets to complain either about mid-level encroachment or about physician oversupply, but not both. I believe the former is the real threat to our profession.

Right because everything is black and white.
 
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RustedFox

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I would love to see this with some sort of effect on what kind of residencies are getting funded too.

We’ve got enough EM residencies for one lifetime, but there’s some (primary care) fields that could sorely use more docs.


We absolutely need more primary care docs.
But even more than that, we need more GOOD primary care docs.
I'm going to estimate that 1/4 to 1/3rd of the primary care docs (not MLPs, mind you) in my area are either (1.) just refill machines or (2.) go to the far end of the whacko spectrum and regularly recommend "heavy metal chelation", "high-dose IV vitamins", and other various voodoo that is not at all evidence-based, nor even pathophysiologically plausible.

They love the "chronic lyme" chrowd [sic, for humor] from New England that comes down here to winter for 6-8 months out of the year. If you're a 67 year old deconditioned female from Bahhstan who is upset about the fact that your'e fat and old... well, you're in luck! We have plenty of folks down here who will pump you full of useless antibiotics and tell you that you're a "victim" of chronic lyme disease.

We have one local PCP that also works as a hospitalist 1-2 days a week.
He or she is actually very good with critical illness, and knows a good deal of medicine.
But he or she also runs a very expensive vitamin shop and chelation clinic the other 4-5 days a week, and its clear that the patients are being taken advantage of.

Sorry, can't get behind that.
 
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The Knife & Gun Club

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We absolutely need more primary care docs.
But even more than that, we need more GOOD primary care docs.
I'm going to estimate that 1/4 to 1/3rd of the primary care docs (not MLPs, mind you) in my area are either (1.) just refill machines or (2.) go to the far end of the whacko spectrum and regularly recommend "heavy metal chelation", "high-dose IV vitamins", and other various voodoo that is not at all evidence-based, nor even pathophysiologically plausible.

They love the "chronic lyme" chrowd [sic, for humor] from New England that comes down here to winter for 6-8 months out of the year. If you're a 67 year old deconditioned female from Bahhstan who is upset about the fact that your'e fat and old... well, you're in luck! We have plenty of folks down here who will pump you full of useless antibiotics and tell you that you're a "victim" of chronic lyme disease.

We have one local PCP that also works as a hospitalist 1-2 days a week.
He or she is actually very good with critical illness, and knows a good deal of medicine.
But he or she also runs a very expensive vitamin shop and chelation clinic the other 4-5 days a week, and its clear that the patients are being taken advantage of.

Sorry, can't get behind that.

I do wonder how many of these people actually believe what they’re doing makes sense vs are just fleecing the rubes dumb enough to believe this garbage.

Just this week an FM resident on her ED month proposed admission for chronic Lyme workup and pain control. When this idea was (roundly) rejected the resident went awol and told the patient they had chronic Lyme anyway and recommended they follow up at the local naturopath clinic.
 
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VA Hopeful Dr

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I do wonder how many of these people actually believe what they’re doing makes sense vs are just fleecing the rubes dumb enough to believe this garbage.

Just this week an FM resident on her ED month proposed admission for chronic Lyme workup and pain control. When this idea was (roundly) rejected the resident went awol and told the patient they had chronic Lyme anyway and recommended they follow up at the local naturopath clinic.
Said resident needs to be disciplined
 
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TooMuchResearch

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I do wonder how many of these people actually believe what they’re doing makes sense vs are just fleecing the rubes dumb enough to believe this garbage.

Just this week an FM resident on her ED month proposed admission for chronic Lyme workup and pain control. When this idea was (roundly) rejected the resident went awol and told the patient they had chronic Lyme anyway and recommended they follow up at the local naturopath clinic.
Whaaaaat? They're not supposed to go that route (the fleece the patient route) until after residency.
 
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I'm of the opinion that one gets to complain either about mid-level encroachment or about physician oversupply, but not both.

I don't understand how you are seeing a dissonance here. It's perfectly consistent to complain about both. In fact, belief in physician oversupply only strengthens the case against midlevels. It's only in world where the "physician shortage" is a real thing that the case for midlevels can be made on grounds other than muh cheap labor.

At any rate, the reason midlevels are being hired isn't because physicians aren't available. I'm in a large, popular coastal city with an enormous glut of doctors, but every hospital and clinic I've rotated at or visited is crawling with midlevels despite every new graduating resident and their mother beating down the doors to work in large coastal cities.

So long as physicians can demand a significantly higher salary than nurses, nurses will continue to be preferentially hired for whatever roles the employer can get away with. The only way residency expansion would put the kibosh on midlevel encroachment would be via creating such an oversupply of doctors as to lower our salaries to nursing rates, thus taking away their cost advantage. Needless to say, the notion that we're going to fight the nursing threat to our pay by preemptively destroying our pay is completely absurd.
 
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