Soon to be PGY-1 in EM reacting to ACEP's recent news

[QuentinT88]

Hey all. I've stepped away from sdn for some time, but think its a useful forum to be able to discuss issues that we are all facing.

I am a soon to be PGY-1 in Emergency Medicine, recently matched almost a month ago to my #1 choice program. Like many of you, I have been interested and invested in EM for a LONG time, so I was thrilled with the match news. However, over the past few days, the recent news from ACEP about the EM supply/demand concerns are extremely disheartening. I feel an incredible sense of anger and frustration to think that after going through medical school, soon to be residency, and after all of the sacrifices ( and debt!) that we have made to get to this point, the prospect of NOT having enough jobs for graduating residents in the soon to be future is just flat out absurd and unacceptable.

I have been aware of the some of the issues of increased EM programs/midlevel creep etc on the field for a few years, but I mainly attributed to negativity on sdn to "doom and gloom" folks. Man was I mistaken though.

It sucks b/c right when I should be motivated to be fired up for the start of residency, I now have a tremendous amount of anxiety about the future of this field. It's sucked all the excitement about residency and medicine out of me. Are any other PGY-1's or residents in the same boat? How are you guys coping with this stress/news? I know i'm not the only one who feels a little misled and screwed by all of this.

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[medgator]

This is going to be a lot of rad Onc residents very soon...

 

[deleted813736]

the golden era for ER is certainly coming to a close. 300/hr jobs are rarities and even recruiters aren't terribly interested in EM folk right now. It sucks but a lot of times things are cyclical and come and go in waves. Maybe 5-10 years from now demand will surge again. No one truly knows. All we know is right now at this moment, we are screwed until there are some major changes. Sorry dude I'm a realist and anyone who thinks there is decent jobs in metro areas is just flat out wrong or misleading.

 

[Rekt]

Hey all. I've stepped away from sdn for some time, but think its a useful forum to be able to discuss issues that we are all facing.

I am a soon to be PGY-1 in Emergency Medicine, recently matched almost a month ago to my #1 choice program. Like many of you, I have been interested and invested in EM for a LONG time, so I was thrilled with the match news. However, over the past few days, the recent news from ACEP about the EM supply/demand concerns are extremely disheartening. I feel an incredible sense of anger and frustration to think that after going through medical school, soon to be residency, and after all of the sacrifices ( and debt!) that we have made to get to this point, the prospect of NOT having enough jobs for graduating residents in the soon to be future is just flat out absurd and unacceptable.

I have been aware of the some of the issues of increased EM programs/midlevel creep etc on the field for a few years, but I mainly attributed to negativity on sdn to "doom and gloom" folks. Man was I mistaken though.

It sucks b/c right when I should be motivated to be fired up for the start of residency, I now have a tremendous amount of anxiety about the future of this field. It's sucked all the excitement about residency and medicine out of me. Are any other PGY-1's or residents in the same boat? How are you guys coping with this stress/news? I know i'm not the only one who feels a little misled and screwed by all of this.

You're in a perfect position to immediately leave EM, which is what I would do if I was an incoming intern.

I've been following all the discussion extremely closely since Friday about all the potential solutions/proposals/discsussions, etc.

The gist is that nothing is going to happen or change anything of any significance. People's ideas are either too grandiose or too minute to matter. The organizations are too busy arguing with each other while new programs are still even opening right now.

the golden era for ER is certainly coming to a close. 300/hr jobs are rarities and even recruiters are terribly interested in EM folk right now. It sucks but a lot of times things are cyclical and come and go in waves. Maybe 5-10 years from now demand will surge again. No one truly knows. All we know is right now at this moment, we are screwed until there are some major changes. Sorry dude I'm a realist and anyone who thinks there is decent jobs in metro areas is just flat out wrong or misleading.

Nothing like this has ever happened before. This isn't one of those "cyclical" times. The trajectory is only downward and unemployment will start within 2-3 years.

 

[medgator]

Maybe 5-10 years from now demand will surge again. No one truly knows. All we know is right now at this moment, we are screwed until there are some major changes. .

Sounds a lot like rad Onc... Too many slots meeting reduced demand (APPs/covid for EM, hypofractionation and reimbursement changes for rad onc).

Bottom line imo is that both specialties are radioactive for at least 5 years or so minimum. Rad onc academia is still the ostrich with their head in the sand in many places, sounds like ER national organizations may at least have a head start there.

Only way either specialty becomes palatable again imo is a dramatic reduction in slots offered in the match. Personally wouldn't touch rad Onc until we see a 40-50% reduction in slots

 

[NYEMMED]

Hey all. I've stepped away from sdn for some time, but think its a useful forum to be able to discuss issues that we are all facing.

I am a soon to be PGY-1 in Emergency Medicine, recently matched almost a month ago to my #1 choice program. Like many of you, I have been interested and invested in EM for a LONG time, so I was thrilled with the match news. However, over the past few days, the recent news from ACEP about the EM supply/demand concerns are extremely disheartening. I feel an incredible sense of anger and frustration to think that after going through medical school, soon to be residency, and after all of the sacrifices ( and debt!) that we have made to get to this point, the prospect of NOT having enough jobs for graduating residents in the soon to be future is just flat out absurd and unacceptable.

I have been aware of the some of the issues of increased EM programs/midlevel creep etc on the field for a few years, but I mainly attributed to negativity on sdn to "doom and gloom" folks. Man was I mistaken though.

It sucks b/c right when I should be motivated to be fired up for the start of residency, I now have a tremendous amount of anxiety about the future of this field. It's sucked all the excitement about residency and medicine out of me. Are any other PGY-1's or residents in the same boat? How are you guys coping with this stress/news? I know i'm not the only one who feels a little misled and screwed by all of this.

You need to get out while you can. Otherwise you will have debt with no way of making money. Switch specialties while you still can...

 

[LibBum]

Want to swap intern positions?

 

[ace_inhibitor111]

Switching specialties is too difficult under the current GME environment. Just finish and hope you aren’t part of the 5-10% unemployed. The 20% unemployment estimate isn’t expected to hit until 2030, and will likely disproportionately affect those from HCA residencies, fresh out of residency graduates, or those who are too old.

 

[deleted813736]

Switching specialties is too difficult under the current GME environment. Just finish and hope you aren’t part of the 5-10% unemployed. The 20% unemployment estimate isn’t expected to hit until 2030, and will likely disproportionately affect those from HCA residencies, fresh out of residency graduates, or those who are too old.

yes^ what this guy said. Just finish your residency. At worst, costco will hire for 15 an hour with great benefits.

 

[DeadCactus]

The right option is going to depend on your priorities and risk tolerance.

You can finish residency hoping to sneak-in just before the complete collapse of the job market and anticipating the need to take very undesirable jobs with little geographic control. This makes the most sense if you really cant see yourself doing anything but emergency medicine and you're hopeful that market and political forces will correct and lead to a better job outlook in the 5+ year future. You probably want to be comfortable with some sort of back-up plan whether that is urgent care, moving to another country, or doing additional training (second residency, fellowship, wound care, etc).

You can accept your first year as a sunk cost and hit the ground running planning to re-apply to the match and change specialties. You're interested in EM, you presumably like a broad range of medical fields and can likely find a career in field with better job prospects. People do this every year, it's not difficult but requires some planning. You probably won't match into dermatology or neurosurgery unless you randomly were working toward that direction before deciding on emergency medicine. Still, an FM or IM residency (to pick two examples) would be reasonably achievable and are both very flexible. They are susceptible to mid-level encroachment but the vast demand for them is rather protective. The issue with GME Medicare funding are vastly overstated on here and based on outdated information regarding how residency programs are funded.

 

[hector10]

Say I wanted to finish up EM as I’m about to start my pgy2 year and apply to IM or FM residency.
Would I be required to do a full 3 years?
Would funding be an issue ?
would I have to apply through Eras or can I just contact PDs directly ?

this is such a ****ty situation, and I am weighing all my options. I didn’t take any gap years so I’m relatively young.

god thinking about redoing an intern year is killing me, but would like to hear more info

 

[Rekt]

Say I wanted to finish up EM as I’m about to start my pgy2 year and apply to IM or FM residency.
Would I be required to do a full 3 years?
Would funding be an issue ?
would I have to apply through Eras or can I just contact PDs directly ?

this is such a ****ty situation, and I am weighing all my options. I didn’t take any gap years so I’m relatively young.

god thinking about redoing an intern year is killing me, but would like to hear more info

You'd get credit. Likely depends on individual programs and unsure how it would affect the timeline though.

The funding is complicated and multifactorial. It's largely a myth that it's based only on number of years. There's other funding and/or if a place is over cap anyway then it doesn't matter etc.

 

[DeadCactus]

Say I wanted to finish up EM as I’m about to start my pgy2 year and apply to IM or FM residency.
Would I be required to do a full 3 years?
Would funding be an issue ?
would I have to apply through Eras or can I just contact PDs directly ?

this is such a ****ty situation, and I am weighing all my options. I didn’t take any gap years so I’m relatively young.

god thinking about redoing an intern year is killing me, but would like to hear more info

I would plan on doing a full 3 years with extra elective time, I would hope for 6 months of credit, and I would be really surprised if you got a full year of credit and came in as a PGY-2. You might be able to negotiate coming as a PGY-2 if you look for an empty PGY-2 position someone left.

Medicaid used to fund the vast majority of GME. The way funding worked is that the day you started a residency, funding to cover the duration of that residency was earmarked for you. For example, if you started a General Surgery residency then you got 5 years of funding but if you started a Family Medicine residency then you got 3 years of funding. That funding followed you and once you spent a year it was gone. So if you left an FM residency after intern year, you only had 2 years of GME funding left. You would have to find a program willing to graduate you in 2 years or that would pay for the extra training themselves. You can imagine convincing a program to pay $100k+ a year (salary, benefits, and program overhead) to train you when someone else comes with government funding is an uphill battle. BUT, Medicaid stopped expanding residency slots decades ago. All the residencies and slots that have arisen since then are funded through other sources. Even institutions still receiving the Medicaid funding likely have non Medicaid funded GME positions. This means they can play a shell game with the money and fund people who wouldn't qualify for Medicaid funding. [This is my understanding from looking into this previously. I welcome contradictory information from more informed people.]

I would apply through ERAS and go through the match. I wouldn't expect anyone to be interested in taking you outside of the match unless it's to fill an unmatched or vacated position.

 

[emergentmd]

If EM is what you like, enjoy residency, and you will be fine.

If you like something else, then look into switching.

Everything usually works out in life eventhough it doesn't seem right at this time.

 

[SunBakedTrash]

It’s not the end of the world and it will extend to all of medicine. Hospital based specialties will be the first to fall. Pathology is the end result- chronic underemployment with reduced geographic flexibility. Honestly do the thing that makes you the least miserable and FIRE as soon as you comfortably can.

This was done on purpose. Can you guess who benefits from an oversupply of doctors willing to accept low pay and literally any job available? Like everything else, follow the $$$.

 

[Spikebd]

Gun for something like general surgery. Much more protected from midlevels. Gut out the residency and once you finish you’ll be good to go.

 

[Bea5T]

Switching specialties is too difficult under the current GME environment. Just finish and hope you aren’t part of the 5-10% unemployed. The 20% unemployment estimate isn’t expected to hit until 2030, and will likely disproportionately affect those from HCA residencies, fresh out of residency graduates, or those who are too old.

All he has to do is re apply for the match

 

[QuentinT88]

What realistically can be done about this? Granted, the report was just a projection. I know that a lot can change in the future, but man..... And I am aware of supply/demand being cyclical in medicine [ex; radiology, anesthesia in the past, rad-onc] but sheesh....this feels kind of permanent. But what do i know....

The AAEM is having a town-hall tomorrow night [4/14] to address solutions, but i'm just skeptical about what kind of power that organizations like AAEM have to make actual change? From my understanding, approval of new residency programs and changes of the number of slots need to come through ACGME, and thats with organizations like ACEP not really doing any favors. I've read that they can't just close new programs bc of anti-trust laws. And lord knows they don't have any power over the staffing of mid-levels who aren't board certified in EM....the list goes on

I appreciate everyones feedback. It would've been good to hear from fellow soon to by PGY-1's but i guess everyone is taking the news differently.

I'm currently weighing the options of re-applying to the match as a PGY-1 for Psych or Anesthesia [even though honestly I didn't love either one, but compared to everything else in medicine that ive been exposed to, these are doable].....Or I could choose to stick with EM and expect terrible locations/limited jobs and reduced pay with crazy stupid debt.....what a time to be alive, right? I went into EM b/c I truly loved the work and everything about it compared to other fields, but if this truly is a dying field i can hardly see it worth staying in EM as an MD with all the cons outweighing the pros

 

[ace_inhibitor111]

All he has to do is re apply for the match

He has to:

1. tell the PD he plans on leaving. Most PDs respond positively but there is always a risk they won’t. Regardless, the PD will start looking for a replacement, so you better match this year or you might not have any job at all
2. acquire new letters of recommendation and better hope your PD is supportive. Also, IM programs last year required a standardized letter from an IM PD. It seems like a pain in the ass to get a good one since you’re just a new intern and this isn’t your medical school
3. somehow schedule interviews while he’s at work. Remember how difficult it was to schedule interviews when spots would get filled in 5 minutes?
4. use vacation days/days off to schedule interviews. Very hard when vacation days are limited and also set many months in advance
5. still have a much lower chance of getting interviews/getting ranked because of US Grad status. According to the PD survey, only 30% of IM programs frequently interview or rank US grads
6. harder to get matched to a good place this year since there will likely be an uptick of IM applications because of the exodus from EM
7. worry about GME funding as discussed above which may or may not be an issue

Not worth it if he truly got into his “number 1” EM program.

 

[Tenk]

yes^ what this guy said. Just finish your residency. At worst, costco will hire for 15 an hour with great benefits.

 

[QuentinT88]

"As the U.S. comes out of the pandemic, Merritt Hawkins predicts demand for physicians will surge again, particularly in certain specialties. “Demand for physicians on the front lines of virus care, including emergency medicine physicians, pulmonologists/critical care physicians, and infectious disease specialists is projected to increase as a result of Covid-19,” the company said in its report."

Pandemic Turns Physician Job Market To Dire From Demand

The ability of a U.S. physician to land a job has been easy until a surge of U. S. cases of the coronavirus strain Covid-19 “flipped” the job market and reduced the demand for doctors during the pandemic, a new report shows.

www.forbes.com

I remember when I was applying to EM last summer/fall, this article helped to reduce some of my concerns about the EM hiring issues. I guess Merrit Hawkins was way off in their predictions....smh

 

[QuentinT88]

Its also crazy to me how according to this report, in 2018/2019 EM was the #11 most recruited specialty in medicine, and now its completely turned upside down in just 3/4 years...absurd

Physician Starting Salaries by Specialty: 2019 vs. 2018 | Merritt Hawkins

While average physician salaries are climbing, the latest recruiting data comparing 2019 to 2018 shows every specialty is different. Discover how the starting salaries for the 20 most-in-demand specialties compare.

www.merritthawkins.com

 

[RuralEDDoc]

...but i'm just skeptical about what kind of power that organizations like AAEM have to make actual change? From my understanding, approval of new residency programs and changes of the number of slots need to come through ACGME, and thats with organizations like ACEP not really doing any favors.

AAEM has more power than you might imagine. Small voices can be very influential. I think ACEP still might not be talking about this if not for AAEMs pressure. Smaller organizations can start movements and coalitions of organizations to move toward collective action, and I think AAEM will be a growing influence in this arena.

 

[QuentinT88]

My SO is one. Our new joke is I have to be the sugar momma in case he can't find a job

I'm going into IM. I just laugh (cry) in hospitalist...

I'm sure your SO is just as pissed/annoyed as me to know that our decisions would've been drastically different had this information come out months before

 

[QuentinT88]

AAEM has more power than you might imagine. Small voices can be very influential. I think ACEP still might not be talking about this if not for AAEMs pressure. Smaller organizations can start movements and coalitions of organizations to move toward collective action, and I think AAEM will be a growing influence in this arena.

I will say I am interested to hear the ideas they will propose to get PE and corporate entities out of EM/medicine. I do hope that you're right about momentum leading to legislation or action, which is needed.... but my fear is that it might be extremely difficult to change the current state of affairs. ugh

 

[emergentmd]

If I change don’t go another hospital based field. In 4 yrs when ur done, these fields will have the same issues.

It would stink if you changed to say anesthesia and wake up 4 yrs with the same issues but for some reason EM is bright again due to some unforeseen change.

 

[partypantss]

From what I've seen, many of the processes that have impacted EM are underway in most other specialties as well. I think EM is just the first to get hit this hard, but if things continue the way they have been, it's just a matter of time before most other specialties start having similar projections. Especially if you're in a good residency I think at this point it isn't crazy to just get through the 3 years (or 4 I guess) of residency and re-asses from there. The way I see it, worst case scenario I have my completed EM residency to my name and then am forced to go back and complete a residency in another field. I think as a practicing physician you can set yourself up to be much more competitive when applying to residencies than as an intern trying to jump ship. Abandoning a solid EM program for whatever random IM/FM place will take you is a tough sell, although maybe I'm an idiot.

 

[2021Doctor]

From what I've seen, many of the processes that have impacted EM are underway in most other specialties as well. I think EM is just the first to get hit this hard, but if things continue the way they have been, it's just a matter of time before most other specialties start having similar projections. Especially if you're in a good residency I think at this point it isn't crazy to just get through the 3 years (or 4 I guess) of residency and re-asses from there. The way I see it, worst case scenario I have my completed EM residency to my name and then am forced to go back and complete a residency in another field. I think as a practicing physician you can set yourself up to be much more competitive when applying to residencies than as an intern trying to jump ship. Abandoning a solid EM program for whatever random IM/FM place will take you is a tough sell, although maybe I'm an idiot.

This not workable imo.

Matching a fresh grad out of medical school with untouched Medicare funding is more profitable for the hospital than training a physician that does not bring with them the full amount of compensation. For this reason, be prepared for rejection, many hospitals cannot afford to take the hit which is understandable. When applying many institutions rejected my application just based on this including my very own in-house residency.

The Art of Pursuing a Second Medical Residency. It Was Right For Me and Can Also Be For You. Five Things to Consider.

Years of medical training, debt and sacrifice culminates with going all in while a computer system decides what you will be doing everyday for the rest of your life. Welcome to graduate medical edu…

theradmed.com

 

[partypantss]

This not workable imo.
View attachment 334810
Matching a fresh grad out of medical school with untouched Medicare funding is more profitable for the hospital than training a physician that does not bring with them the full amount of compensation. For this reason, be prepared for rejection, many hospitals cannot afford to take the hit which is understandable. When applying many institutions rejected my application just based on this including my very own in-house residency.

The Art of Pursuing a Second Medical Residency. It Was Right For Me and Can Also Be For You. Five Things to Consider.

Years of medical training, debt and sacrifice culminates with going all in while a computer system decides what you will be doing everyday for the rest of your life. Welcome to graduate medical edu…

theradmed.com

Could you elaborate on why it's not workable to go back to complete a second residency after graduating? It was my understanding that it does happen.

 

[RustedFox]

Could you elaborate on why it's not workable to go back to complete a second residency after graduating? It was my understanding that it does happen.

Yeah; I can name more than a few folks who have done this. Including some FM attendings who entered EM residencies a few years back.

The word around here (Faculty step in, plz) is that funding isn't a problem in a lot of cases, as the medicaid dept doesn't find things like they used to.

 

[QuentinT88]

Team Health Residency Sparks Controversy : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

AAEM has been warning against CMG involvement in residencies for years......jesus

 

[CurbYourExpectations]

I believe bigger programs in family medicine are more likely to have extra funding around for people who are trying to transfer. Just make sure that family medicine is truly interesting to you if you choose that route, because that’s what they value most. I’m sure a lot of family Med places would be happy to have a good, former EM trained/in training doc.

I think whether you’re an em trainee with funding left over or an attending with no funding you will be able to find a FM spot somewhere if they determine you would be a good and compassionate FM doc.

 

[katherinedriscoll]

The right option is going to depend on your priorities and risk tolerance.

You can finish residency hoping to sneak-in just before the complete collapse of the job market and anticipating the need to take very undesirable jobs with little geographic control. This makes the most sense if you really cant see yourself doing anything but emergency medicine and you're hopeful that market and political forces will correct and lead to a better job outlook in the 5+ year future. You probably want to be comfortable with some sort of back-up plan whether that is urgent care, moving to another country, or doing additional training (second residency, fellowship, wound care, etc).

You can accept your first year as a sunk cost and hit the ground running planning to re-apply to the match and change specialties. You're interested in EM, you presumably like a broad range of medical fields and can likely find a career in field with better job prospects. People do this every year, it's not difficult but requires some planning. You probably won't match into dermatology or neurosurgery unless you randomly were working toward that direction before deciding on emergency medicine. Still, an FM or IM residency (to pick two examples) would be reasonably achievable and are both very flexible. They are susceptible to mid-level encroachment but the vast demand for them is rather protective. The issue with GME Medicare funding are vastly overstated on here and based on outdated information regarding how residency programs are funded.

I would plan on doing a full 3 years with extra elective time, I would hope for 6 months of credit, and I would be really surprised if you got a full year of credit and came in as a PGY-2. You might be able to negotiate coming as a PGY-2 if you look for an empty PGY-2 position someone left.

Medicaid used to fund the vast majority of GME. The way funding worked is that the day you started a residency, funding to cover the duration of that residency was earmarked for you. For example, if you started a General Surgery residency then you got 5 years of funding but if you started a Family Medicine residency then you got 3 years of funding. That funding followed you and once you spent a year it was gone. So if you left an FM residency after intern year, you only had 2 years of GME funding left. You would have to find a program willing to graduate you in 2 years or that would pay for the extra training themselves. You can imagine convincing a program to pay $100k+ a year (salary, benefits, and program overhead) to train you when someone else comes with government funding is an uphill battle. BUT, Medicaid stopped expanding residency slots decades ago. All the residencies and slots that have arisen since then are funded through other sources. Even institutions still receiving the Medicaid funding likely have non Medicaid funded GME positions. This means they can play a shell game with the money and fund people who wouldn't qualify for Medicaid funding. [This is my understanding from looking into this previously. I welcome contradictory information from more informed people.]

I would apply through ERAS and go through the match. I wouldn't expect anyone to be interested in taking you outside of the match unless it's to fill an unmatched or vacated position.

As a PGY-1 that just went through the process of switching out of EM, this is all spot-on. I can also confirm that it really isn't that uncommon. Most people I've talked to about it usually know at least one other doctor that started in one specialty and ended up in another.

Time will tell whether or not I made the right decision, but right now I have absolutely no regrets about going through with it. EM can be a lot of fun, but for me it is just too stressful of a job to also bear the added weight of not knowing if I'll be able to find a decent job in the same state as my family, let alone metro area. At the end of the day it's still just a way to earn a paycheck.

 

[2021Doctor]

As a PGY-1 that just went through the process of switching out of EM, this is all spot-on. I can also confirm that it really isn't that uncommon. Most people I've talked to about it usually know at least one other doctor that started in one specialty and ended up in another.

Time will tell whether or not I made the right decision, but right now I have absolutely no regrets about going through with it. EM can be a lot of fun, but for me it is just too stressful of a job to also bear the added weight of not knowing if I'll be able to find a decent job in the same state as my family, let alone metro area. At the end of the day it's still just a way to earn a paycheck.

Did you go through the match again or did you get a position outside of the match?

 

[cyanide12345678]

I'm sure your SO is just as pissed/annoyed as me to know that our decisions would've been drastically different had this information come out months before

This information was technically out months ago. Every single person on here was taking about how job hunting had changed, how last year's class wasn't able to find jobs etc. Med students just ignore the advice of those who are truly in the profession and assume it's just gloom and Doom for no reason.

 

[QuentinT88]

Team Health Residency Sparks Controversy : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

AAEM has been warning against CMG involvement in residencies for years......jesus

This information was technically out months ago. Every single person on here was taking about how job hunting had changed, how last year's class wasn't able to find jobs etc. Med students just ignore the advice of those who are truly in the profession and assume it's just gloom and Doom for no reason.

No, the workforce study by ACEP was not out months ago, that is what i'm referring to. Incoming residents like myself read these forums last year and alot of the job issues were attributed to mainly COVID and reduced volume. I reached out to multiple attending's and residents about the job market, and they all were re-assuring that it was all covid. I'm not just a med student whose been operating with my head in the sand.

The issues of oversupply were not as clearly known to everyone in the EM community until the formal study. And lets be honest, you can't fault us for going forward with EM despite the doom and gloom without any concrete data when so many of us were dead set on EM from the beginning, but would have made other choices if this formal information was presented months ago.

 

[Rekt]

Team Health Residency Sparks Controversy : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

AAEM has been warning against CMG involvement in residencies for years......jesus

No, the workforce study by ACEP was not out months ago, that is what i'm referring to. Incoming residents like myself read these forums last year and alot of the job issues were attributed to mainly COVID and reduced volume. I reached out to multiple attending's and residents about the job market, and they all were re-assuring that it was all covid. I'm not just a med student whose been operating with my head in the sand.

The issues of oversupply were not as clearly known to everyone in the EM community until the formal study. And lets be honest, you can't fault us for going forward with EM despite the doom and gloom without any concrete data when so many of us were dead set on EM from the beginning, but would have made other choices if this formal information was presented months ago.

AAEM did a formal study showing 20-30% pre-COVID by 2030 in 2018.

 

[QuentinT88]

So this will be my final post on this topic for a while. I'm going to take a long hiatus from sdn for the betterment of my personal and mental health haha.

- I was on the call with AAEM last night, and I appreciated how this seems to be a galvanizing event in EM.
- I'm hopeful that now that the information is much more widely known, necessary changes can be implemented to improve the future
- I'm not quite sure what direction I will go, staying in EM vs fellowship vs switching residencies. I'll be meeting with advisors to discuss my options
- All in all, these are projections and as worrisome as they are, a lot can happen in 9-10years. So i'm going to stop worrying so much and prepare for the worst, hope for the best
- to my fellow PGY-1's soon to be starting residency reading this, best of luck!

 

[miacomet]

Team Health Residency Sparks Controversy : Emergency Medicine News

An abstract is unavailable.

journals.lww.com

AAEM has been warning against CMG involvement in residencies for years......jesus

No, the workforce study by ACEP was not out months ago, that is what i'm referring to. Incoming residents like myself read these forums last year and alot of the job issues were attributed to mainly COVID and reduced volume. I reached out to multiple attending's and residents about the job market, and they all were re-assuring that it was all covid. I'm not just a med student whose been operating with my head in the sand.

The issues of oversupply were not as clearly known to everyone in the EM community until the formal study. And lets be honest, you can't fault us for going forward with EM despite the doom and gloom without any concrete data when so many of us were dead set on EM from the beginning, but would have made other choices if this formal information was presented months ago.

Attendings and residents at a residency program have their own biases. Not a great source of info, fwiw.

 

[pandahunter]

Anyone who is about to be PGY1 or still in med school needs to consider switching out of the EM track if they plan on living in a major metro area. I'm a recent grad from a few years ago in a big Cali city and there's really no full time gigs to be had right now unless you come in saying you're willing to work for less than 170/hr. My friends of the same year who live in Seattle, NYC, Portland and Austin are have luckily secured full time gigs (from 3 years ago) but note that none of their shops are planning on hiring anytime this year. The squeeze perhaps hasn't occurred in middle america yet but I suspect it will within the next 5 years.

Oversupply of residents from these new programs has crushed the market. And with the rise of telemedicine, the demand of acute care physicians will remain low. There is no prospect for recovery unless a significant number of residencies are shut down, which will never happen. To anyone in training or just coming out of residency, you may be screwed. For anyone still in med school, you still have time to pick a different career path. Save yourself.

 

[CurbYourExpectations]

If you truly want to be safe and have options and don’t want to do surgery I think IM and FM are the best options at this point. Plenty of options. Hard to replace good IM and FM docs with mid. Can subspecialize fairly easily. Inpatient or outpatient, can open your own clinic, can do cash only work with no hospital affiliation. Plus they incorporate a large portion of EM, less of the exciting cases and undifferentiated diagnosis (why I loved EM), but more patient appreciation and unfortunately job security. IM and FM doctors make monetary sense over mid levels currently, which is huge if you want to practice general, broad medicine.

I feel for all of you newbies and I’m truly empathetic with all of your stress. I’ve spoken with senior EM attendings at a big locations and they are worried for their residents. I am not in EM and have no skin in the game. Family medicine and internal medicine are great alternatives and are very enjoyable, for other reasons.

 

[katherinedriscoll]

@katherinedriscoll what did you switch into?

FM.

Did you go through the match again or did you get a position outside of the match?

I went through the match.

 

[2021Doctor]

FM.



I went through the match.

Props for sharing your story.

 

[emergentmd]

EM is the tipping point/test tube case for HCA and the like. Just browse all the HCA residencies and you will see most of the fields including radiology/dermatology/surgery.

Unless you can open your own practice and not depend on a hospital, you are vulnerable. If you think GS is safe, what will happen in 5-10 yrs when HCA pops out 2x the number of surgeons?

 

[partypantss]

EM is the tipping point/test tube case for HCA and the like. Just browse all the HCA residencies and you will see most of the fields including radiology/dermatology/surgery.

Unless you can open your own practice and not depend on a hospital, you are vulnerable. If you think GS is safe, what will happen in 5-10 yrs when HCA pops out 2x the number of surgeons?

Yes, the more I look into the current state of other specialties, the more I'm becoming convinced that EM is just the tip of the crap-filled iceberg. These changes are coming for medicine as a whole. Opening your own practice may be one safety measure, but that too is becoming increasingly difficult to do successfully as time goes on. EM may have been the most vulnerable for reasons that are fairly easy to identify, but that just means EM was first to get hit, but almost certainly are not the last. I think ultimately all the hospital-based specialties are going to be in this together, either everyone eventually gets screwed or things change. This does lend support for the argument of just do what you enjoy.

 

[Redpancreas]

Could you elaborate on why it's not workable to go back to complete a second residency after graduating? It was my understanding that it does happen.

Yeah; I can name more than a few folks who have done this. Including some FM attendings who entered EM residencies a few years back.

The word around here (Faculty step in, plz) is that funding isn't a problem in a lot of cases, as the medicaid dept doesn't find things like they used to.

Residency is funded by Medicare. There are two funding streams. Indirect Medical Education (IME - malpractice insurance, etc.) and Direct Medical Education (DME - resident salary, etc.). IME > DME. Medicare will always cover 100% of the IME and 50% of the DME even if you have used up all your residency funding, resulting in >75% funding per years you've used up. In addition, many large hospitals can eat the cost for other reasons making funding a non-issue.

Tl;Dr: Residency funding is not a major issue, but an excuse.

 

[emergentmd]

If I was running a business that was somewhat profitable and wanted to make it more profitable, I could cut the lowest hanging fruit/high cost which for hospitals are physician salary.

If a hospital system wanted to replace their 30 radiologist x 500K, 40 ER docs x 350K, 20 hospitalist x 300k, 15 surgeons x 500k which costs $45M a year they would just need 10 radiologist, 10 ER docs, 5 hospitalist, 5 surgeons to manage the 25 rad, 40 ER, 20 IM, 15 surg residents making them work 1.5-2x attending hours.

Easy economic decision.

 

[inthezone2]

HCA has been churning out quite a large number of IM residencies. If ya'll want to abandon EM for IM, I'd advise not leaving for any random position. IM probably has one of the greatest gaps in competitivity between top and low tier programs. Your chances of matching a desirable fellowship is proportional to where your program is on that spectrum.

 

[emergentmd]

Very wise words but HCA can easily fix that. They will eventually create Card/GI fellowships and just plug in their own IM residents. They already have Derm, ortho, optho. Nothing is stopping them from adding NSG and the like.

Truthfully the current attendings probably love it. The work less hours and essentially just do fluff talks/operate. They don't need to do what they hate which typically is clinics, rounds, taking calls.

 

[inthezone2]

I think we can learn a lot from law and other professions. There will be contractions in earnings, etc overall, but the people going to mid-top tier institutions should be fine owing to brand name and good alumni network.

If I were going into EM, I'd probably stick it out if my program is well known in the top half of EM programs. The projections look bad and EM residents should rightfully be worried, but ditching a mid or higher tier EM program to go match IM is akin to panic selling.