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

[Mushdoc]

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.

People care where their lawyer went to school. People go to the nearest ER

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[inthezone2]

People care where their lawyer went to school. People go to the nearest ER

Big name programs like Hennepin will never have issues with their graduates getting jobs. The name is still important in this context for EM directors and other people in positions of power hiring.

 

[ace_inhibitor111]

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.

Hmm... isn’t that the case because most good law jobs are held by private firms? That doesn’t really fit the job market for EM that well. For EM, sure there are some places that care about prestige/reputation, but if they’re not hiring it won’t matter. Many local hospitals seem to mostly care about hiring from local residencies.

I agree that IM is not the magical back-up plan though. The ACGME requirements are even less than that of EM, and the number of residencies is increasing at a similarly high rate. There is more flexibility in terms of career options which is why we don’t see exactly the same effect, but even now the hospitalist job market is beginning to feel a similar squeeze to that of EM.

 

[bougiecric]

Big name programs like Hennepin will never have issues with their graduates getting jobs. The name is still important in this context for EM directors and other people in positions of power hiring.

Maybe in academics, can't necessarily speak to that.

In the community? We're cogs. They'll take whoever is willing to do it the cheapest, as long as their metrics are being met.

You actually may be better off going to an HCA residency because you'll already be in their pipeline.

 

[turkeyjerky]

Maybe in academics, can't necessarily speak to that.

In the community? We're cogs. They'll take whoever is willing to do it the cheapest, as long as their metrics are being met.

You actually may be better off going to an HCA residency because you'll already be in their pipeline.

This. You really think think Barry from Brentwood knows or cares what residencies were historically strong.

 

[Fox800]

Big name programs like Hennepin will never have issues with their graduates getting jobs. The name is still important in this context for EM directors and other people in positions of power hiring.

You'd be wrong on that one.

 

[RustedFox]

You'd be wrong on that one.

I was waiting for someone else to say it.
I'm tired of being the one to point this out to the MS-(X) crowd who offers an opinion, but has no idea of the outside world.

 

[inthezone2]

I was waiting for someone else to say it.
I'm tired of being the one to point this out to the MS-(X) crowd who offers an opinion, but has no idea of the outside world.

Lol, the academic faculty members and the disillusioned community EM attendings do still have one thing in common, the dick waving. Only in medicine, do we reflexively put forth our ranks to shut down someone else. Can't wait to pull that out my own ass.

If I'm wrong so be it. I still hope it works out and that you all are being more pessimistic than realistic.

 

[RustedFox]

Lol, the academic faculty members and the disillusioned community EM attendings do still have one thing in common, the dick waving. Only in medicine, do we reflexively put forth our ranks to shut down someone else. Can't wait to pull that out my own ass.

If I'm wrong so be it. I still hope it works out and that you all are being more pessimistic than realistic.

I hope it works out, too.

 

[DeadCactus]

I'm going to jump on the dogpile and agree the lawyer analogy is flawed. Accomplished lawyers graduate from accomplished schools to work for accomplished firms that work big cases for big money. Even the Fauci's of the world are seeing CHF exacerbations for Medicare money until they can scrape together administrative and academic buy-down to get out of it. Different market dynamics with a much tighter normal distribution.

The winners in medicine went to the cheapest state school they could, pulled a D for doctor, and went into primary care working 36 hours a week with no nights, weekends, and holidays.

 

[miacomet]

Big name programs like Hennepin will never have issues with their graduates getting jobs. The name is still important in this context for EM directors and other people in positions of power hiring.

Definitely not the case if you work in the community. We routinely turn down applicants with fellowships and who went to "big name" programs. Unless you went to the same program as the directors or graduated from the local residency, it's pretty much irrelevant, as are your publications and ultrasound prowess.

We had over 30 applications for a part-time job. I don't think residency (aside from avoiding HCA) came up once.

 

[GeneralVeers]

If I was hiring now, I'd care less about what residency someone went to and more about experience. Ideally I'd want a doc who's practiced 5-10 years in high volume facilities. At 5 years you are generally at the peak of your game, but haven't had a chance to burn out yet.

 

[Groove]

If I was hiring now, I'd care less about what residency someone went to and more about experience. Ideally I'd want a doc who's practiced 5-10 years in high volume facilities. At 5 years you are generally at the peak of your game, but haven't had a chance to burn out yet.

I feel the same but that's the veteran/geezer bias in me. We have 90% new grads in my new group that are within 1-3 years of experience or fresh out. They are all incredibly solid, well trained and fast. I can beat most of them in disposition speed but not by a lot. Most of them are much better and faster than IM/FM docs of old that I've worked with over the years. We have one exception who's an older IM doc in his 60s that does nights and he's a machine (though he's about to leave now that we are 100% ABEM). All of these youngsters keep me on my toes, not that I'm too old (mid-40s)...yet.

The nice thing about hiring a group of young, fresh docs out of residency is that they are all pretty well trained these days and have no biases, bad habits or bad experiences for that matter. They are easily moldable and will put up with a lot more BS than old guard docs who have a better sense of what are reasonable requests in practice/behavior. If I was a director and wanted an efficient group, with minimal complaining, willing to do whatever I asked...I'd hire 90% fresh grads and sprinkle a few veterans in there for learning.

 

[cyanide12345678]

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.

And the irony is they need a physician to be program director. We happily take these positions and start new programs.

We have no one to blame but us. If physicians put their foot down in not supporting the starting of new residencies and not taking any such job, then residency expansion stops.

 

[cyanide12345678]

Big name programs like Hennepin will never have issues with their graduates getting jobs. The name is still important in this context for EM directors and other people in positions of power hiring.

It doesn't matter. Let's stop this illusion. The references matter, the experience matters. And any red flags in interview matter. That's about it.

 

[MechEDoc]

...it's pretty much irrelevant, as are your publications and ultrasound prowess.

This. I did locums and locums type work for years. Probably 15 different ERs, only one (SDG, not on a locums contract) had ER docs billing for ultrasound. Only once in 5 years has a patient gone to the OR directly based upon a FAST exam. And I'm an ultrasound fan. I have had my own (first Philips Lumify, now Butterfly IQ) for years, use it as part of my exam and do lots of ultrasound guided procedures.

No one cares. You can find wall motion abnormalities on your chest pain patient? Great, try telling that to the cardiology noctor that is trying to block your admission.

Even if you're good at using ultrasound, community hospitals aren't usually to set in their ways to capture this missing revenue.

 

[dadaddadaBATMAN]

Lol, the academic faculty members and the disillusioned community EM attendings do still have one thing in common, the dick waving. Only in medicine, do we reflexively put forth our ranks to shut down someone else. Can't wait to pull that out my own ass.

If I'm wrong so be it. I still hope it works out and that you all are being more pessimistic than realistic.

That’s not really true friend. If a freshman in college started lecturing a current mechanical engineer on their job market, you would probably laugh at them. It turns out that actually experiencing getting hired as an em doc is relevant to opining on...the experience of getting hired.

There is someone pulling things from the depths of their nether regions on this thread. It isn’t rusted fox.

All the best luck to you

 

[EMhawkeye]

Lol, the academic faculty members and the disillusioned community EM attendings do still have one thing in common, the dick waving. Only in medicine, do we reflexively put forth our ranks to shut down someone else. Can't wait to pull that out my own ass.

If I'm wrong so be it. I still hope it works out and that you all are being more pessimistic than realistic.

Man the arrogance. Much to learn you have young grasshopper.