For us young physicians facing this job market, what are ya'lls thoughts on switching specialties? Especially for those of us still in training? Should we plan to work a few years in EM and then go back to retrain in another field when things get really bad or should we bite the bullet and jump ship now? Obviously I like EM better than all the other specialties, but I like being able paying off my student loans even more.
Switching specialties
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I can't say I did this myself, but I don't see why you can't continue working/living like a resident and pay off your loans in a couple years. EM is still highly paid, even if salaries have taken a hit recently due to COVID-19 (and other factors).
In fact, I find one of the "toughest" things about clinical EM is its relatively high pay (i.e. golden handcuffs). I find few options that can earn me as much bang for my buck as EM, which makes me continue giving a piece of my soul every shift that I continue to work in the ER.
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I did EM, then after a few years, did an Interventional Pain fellowship. I'm not sure if that means I "switched specialites" or I simply moved into a subspecialty of Emergency Medicine. But either way, it's worked out well for me. I could've quit and gone back to general EM at any time during the first 1-3 years with no downside if I'd wanted to. I never had the desire. Not even for a second.
The change has reduced my work-related stress, frustration, administrative friction and burnout 90%. It's reduced my circadian rhythm disruption 100%. It's also allowed me to have a normal life, sleep when it's dark, be awake when it's light out, eat when I want to eat and **** when I want to ****. I never work nights, holidays, weekend, kids' birthdays or take call. Ever. Plus, I do cool procedures (epidurals, kyphoplasty, spinal cord stimulators, joint injections) and see less belligerent drug abusers/dealers than I ever did in Emergency Departments. I earn a competitive salary and feel my career is sustainable in a field Anesthesia and PM&R residents have been known to chiv each other to get into. I get cookies, dunkin donuts and homemade jam from patients once every two weeks, as opposed to once per decade. Other than that, it's not too bad.
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If what has been posted on this board lately is to believed, these salaries/jobs aren’t going to last for any meaningful amount of time, which is why I’m looking at potential opportunities in other specialties.
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I sense that you desire a specialty that has a rather positive job outlook. Does this trump your specialty preference? If so, then consider switching. If not, then for sure you can pay off student loans in EM which comes down to smart money management.
Yes. I thought when I was signing up for EM I was signing up for a specialty where I could (within reason) move anywhere. Where i was actually in demand and held the cards during job negotiations. This is obviously not the case anymore.
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Unless you are an NFL QB, that is not true for any job.
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I don't think it'll ever get to the point where you are unable to pay off your student loans (well I guess it depends on exactly how much you have). I'm really not an expert, but my sense is that the last decade was somewhat an anomaly in terms of pay for EM. I'm sure there were always high paying SDGs, but the combination of the ACA and market turmoil led to the across the board increases we've seen recently. In the future, I think we're likely to see a two tier market for jobs--well paying (but difficult to find) SDGs and not-so-well paying CMGs. Whereas up until recently, the former were obtainable and the latter were available across the board, in the future it will tighten considerably. I do think pay rates across the board will come down somewhat due to decreased due to increased pressure from payors, but it'll be the difference between 25% reductions (wild guess) for CMG jobs vs 10% or so for SDGs. I think the days of 350/hr (locums or SDG partners) are gone and numbered, respectively. But I don't think anyone's going to starve, this is a hard job after all and not everyone has the disposition and training to do it. But you'll have to work for that 160/hr.
Whether or not you should start planning your exit now depends on where you're at. Obviously it's easier to get out if you never entered in the first place, which is why I think going into EM right now is idiotic. Part of the problem is that we have rather limited exit options. I would definitely try to keep your options open.
If you're a:
medstudent-->don't apply to EM.
intern-->think about switching (IM, Gas, Rads, surgery, etc)
2nd year-->consider CCM? Or put your head in the sand and hope for the best
3rd year-->good luck
Whether or not you should start planning your exit now depends on where you're at. Obviously it's easier to get out if you never entered in the first place, which is why I think going into EM right now is idiotic. Part of the problem is that we have rather limited exit options. I would definitely try to keep your options open.
If you're a:
medstudent-->don't apply to EM.
intern-->think about switching (IM, Gas, Rads, surgery, etc)
2nd year-->consider CCM? Or put your head in the sand and hope for the best
3rd year-->good luck
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Seems like it's the case for ED nurses...
My friends in FM started getting courted intern year and signed contracts by second year with big fat monthly stipends. And these are not rural jobs.
And they pay a tiny fraction of what EM makes. Your friends are idiots. Stipends are high interest loans.
You can write a cash-advance check off of your credit card; or contact your local member of organized crime, and get the same.
These health care entities are not in the business of losing money.
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That has a lot to do with covid. It should rebound after the pandemic. Maybe not all the way back but it will certainly be better than now.
Also, it's not just our field that has been hit by covid.
To be clear, there are many valid reasons for making a decision to move away from being a "line" EM physician as you age. This may be a change of specialty, a sub-specialty of EM, or mixing in administration, teaching, research, etc.
However, a new specialty will almost never be financially beneficial, especially when one adds in the opportunity cost of a lost 3-5 years of EM salary. It might keep you sane, but it will not make you more desirable or increase your income.
However, a new specialty will almost never be financially beneficial, especially when one adds in the opportunity cost of a lost 3-5 years of EM salary. It might keep you sane, but it will not make you more desirable or increase your income.
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I've had physician friends justify clearly bad exploitative jobs because of the sign-on bonuses and/or stipends. Then I bring up "You know...you could recoup that stipend in a better paying job within like 1-2 months?" It's like it never occurred to them lol.
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Stop thinking about holding the cards in a game of employment poker. Push away from the card table and pick the medical specialties where you can open your own practice.
IM / FM / Psych / Derm / Cards / Endo / Rheum / Peds / etc
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I too choose to lose hundreds of thousands of dollars in income to train for a job I don't really want that likely pays less when I'm worried about my finances.
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U r nuts
TheSingularity
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Endo? Rheum? ....Peds?!?! wtf are you talking about this is terrible advice
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Yeah when i interviewed for residency 4-5 years ago, the attendings couldn't stop talking about all the emails offering 300+/hr they were getting all the time and they could literally go anywhere...
How times have changed -_- 180-220/hr offers in Indiana right now. But granted the gigs are about 1.2-1.4 patients per hour...
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Ignore every specialty in that list except derm, cards, psych.... But man cardiology training is 6 years.
I sure as hell wouldn't want to go through 6 years of training.... They probably come out of training burned out
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Any specialty that doesn't need a hospital or ASC to practice in, can open their open practice.
When you open your own practice you can capture more money in your pocket by having a smaller overhead than the Big Box shops, and in grand summary the difference of your Gross billings and net income/benefits paid out in employment will be higher because you now control the difference between Gross earnings and Net income.
So yes, I'm providing excellent advice for any specialty that can be office based. Woe are those tied to hospitals.
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I think a lot of people who are in training, myself included, are more terrified by the LACK of jobs In some markets rather than the salary drop.
It used to be a choice between well paying rural markets or more modest markets in the large or coastal cities. Now it’s just modest rural markets, no real option to live in one of the major cities.
The loss of decision power is unsettling given most of us entered the physician pipeline 5-7 years ago when virtually any speciality could land a job in virtually any market, but it was just the pay that’s negotiable.
Lots of people have geographic constraints by age 30 where it’s no longer easy to just uproot their spouse +/- kids and head off to rural Indiana so they can find a job.
It used to be a choice between well paying rural markets or more modest markets in the large or coastal cities. Now it’s just modest rural markets, no real option to live in one of the major cities.
The loss of decision power is unsettling given most of us entered the physician pipeline 5-7 years ago when virtually any speciality could land a job in virtually any market, but it was just the pay that’s negotiable.
Lots of people have geographic constraints by age 30 where it’s no longer easy to just uproot their spouse +/- kids and head off to rural Indiana so they can find a job.
Perhaps less true than it used to be, but pretty much every medical specialty will encounter lower demand in desirable areas. Medicine is not immune to market forces.
There are plenty of places and specialties where you can get a job, but the pay will be lower. Perhaps the most portable specialty from a demand point of view right now is primary care.
Even spine surgeons make less money in San Francisco than they do in Beaumont, TX.
Even if you become highly sub-specialized (say a pediatric skull base surgeon/otologist) your market will be very narrow as they are few postings and few hospitals that can even provide that level of specialty care, perhaps only a few per state or region.
An under appreciated reality on this board.
My friend who is a small group private practice gynecologist took an EIGHTY percent pay cut from March-June when elective surgeries were all on hold.
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I just had dinner with a neurosurgeon who claimed he had "no paycheck for three months" due to COVID. I didn't press him on details, or how hard that hit him, but that's what he claimed. I mean, it's not like he was forced to order the chicken, or anything. He still got the steak. Just sayin'.
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Volumes are down, hospital revenue is down, national debt is exploding, and there is a level of social unrest and uncertainty about the future of our country that is unprecedented in just about anyone one here's lifetime. The job market sucks right now, for everyone. Most businesses and all healthcare systems are trying to shelter in place and weather the storm and hiring someone is just an extra expense right now. The risk of this being permanent is about as high as the risk of us collapsing into full-on civil war.
Yes, there are some additional challenges facing EM right now with the expansion of residencies and the higher impact of COVID on hospital based specialties (outpatient providers can adapt telehealth while procedural specialties and the hospitals that rely on them are hurting). Emergency medicine is a 3 year specialty that we've decided needs to be in every single emergency department in the country. As a result, our job market is going to shift to reflect similar specialties like Peds, FM, and IM (3 year residencies we expect to serve every community) with an explosion of residencies of various qualities, a decline in salary to the $200-300k/yr range, and high competition for desirable jobs in desirable areas with a larger pool of rural and other less desirable jobs. We're likely entering an era where training at established residencies, good networking, and developing a niche through fellowship or other training will start to impact finding a job in desirable locations. This isn't any different than any of the other established specialties.
The golden era of $500k+/yr jobs and small democratic groups with partners making close to a million a year and retiring off of buyouts is likely over mostly because of the natural evolution of markets in a capitalistic system (though we like to blame the golden age physicians for selling us out). There is no reason to expect EM to get a particularly bad deal compared to other specialties that fill a similar style of niche in our healthcare system. The only reason EM is "declining" is because it briefly held an untenable position of privilege in our system by being a new but essential component of a capitalistic healthcare system.
The conversations here have been filled with overly dramatic interpretations of the state of our specialty and whimsical fantasies about other specialties. The idea that primary care providers are out there just starting private practices at whim is nonsense. They face the same pressures to become employees and practice as part of corporate medicine as us. They have no easier access to independent practice than we do through urgent cares and small democratic groups. Everyone talks about wanting to hang their own shingle until the reality of putting your family's livelihood into the hands of their ability to start and run a new business in direct competition with national corporations. Comparing EM to specialties that take 5+ years of training is apples and oranges and even then the almost $1 million in income you'd give up and additional years of your life sacrificed to training dwarfs the potential economic benefits if they even exist. That ignores that the well paying ones are heavily procedural and many are hurting even worse than EM is right now.
Yes, there are some additional challenges facing EM right now with the expansion of residencies and the higher impact of COVID on hospital based specialties (outpatient providers can adapt telehealth while procedural specialties and the hospitals that rely on them are hurting). Emergency medicine is a 3 year specialty that we've decided needs to be in every single emergency department in the country. As a result, our job market is going to shift to reflect similar specialties like Peds, FM, and IM (3 year residencies we expect to serve every community) with an explosion of residencies of various qualities, a decline in salary to the $200-300k/yr range, and high competition for desirable jobs in desirable areas with a larger pool of rural and other less desirable jobs. We're likely entering an era where training at established residencies, good networking, and developing a niche through fellowship or other training will start to impact finding a job in desirable locations. This isn't any different than any of the other established specialties.
The golden era of $500k+/yr jobs and small democratic groups with partners making close to a million a year and retiring off of buyouts is likely over mostly because of the natural evolution of markets in a capitalistic system (though we like to blame the golden age physicians for selling us out). There is no reason to expect EM to get a particularly bad deal compared to other specialties that fill a similar style of niche in our healthcare system. The only reason EM is "declining" is because it briefly held an untenable position of privilege in our system by being a new but essential component of a capitalistic healthcare system.
The conversations here have been filled with overly dramatic interpretations of the state of our specialty and whimsical fantasies about other specialties. The idea that primary care providers are out there just starting private practices at whim is nonsense. They face the same pressures to become employees and practice as part of corporate medicine as us. They have no easier access to independent practice than we do through urgent cares and small democratic groups. Everyone talks about wanting to hang their own shingle until the reality of putting your family's livelihood into the hands of their ability to start and run a new business in direct competition with national corporations. Comparing EM to specialties that take 5+ years of training is apples and oranges and even then the almost $1 million in income you'd give up and additional years of your life sacrificed to training dwarfs the potential economic benefits if they even exist. That ignores that the well paying ones are heavily procedural and many are hurting even worse than EM is right now.
The only problem, of course, is that you would have to practice psychiatry.
I can say with absolute certainty that after a year, especially in an all-cash practice, 95% of EM physicians would be admitted to an inpatient unit.
Sure, and since you have no leverage, the insurance companies will offer you $20/visit. There is a reason every private practice and group is joining a hospital system.
If you think you will make it up with self-pay patients, then that is a recipe for disaster. First, patients will lie to you. They will tell you that they will see you even if the insurance will not cover it. They are lying. I know a physician couple who lost everything believing that.
Next, even if you can make a go of it, this type of practice is the first thing to go when the economy goes south. People who are earning less, or paying COBRA rates, are not going to shell out the extra money since they like you.
RIght now I can name five physicians who have gone bankrupt with this strategy.
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I'm glad you are able lecture about what you know of other physicians. I am walking the walk and doing my own private practice, almost crossing year 2 mark, insurance based, and no the sky is not falling, but there are pitfalls to be mindful of.
Psych has not slowed up except maybe private practice cash based. By all measures, psych demand has increased and even our outpatient clinics are even busier than before. As a PGY-4, I just had 8 interviews with recruiters/hospitals today alone. And I just started my job search 2 days ag (dead serious). Im not sure about all the other specialties but I can see the demand for psych staying the same or even getting higher since most psychiatrists are close to retirement age (50s).
I think psychiatry has an excellent outlook financially, but I would encourage posters on this board to realize they do not just print checks for you after you graduated residency. You still have to practice the specialty, and the challenges and satisfactions of being a psychiatrist are very different and probably not interchangeable with a lot of other specialties, including, emergency medicine.
I admire psychiatrists very much, and although there are a lot of days I do not enjoy in the ER, I do not think I would enjoy practicing psychiatry very much.
FWIW we just had over a dozen docs at all career stages apply for PRN positions with no guarantee of a permanent job.
I'd look at psych. It's the same level of pathology as the ED, you just actually treat the problem.
I'd look at psych. It's the same level of pathology as the ED, you just actually treat the problem.
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I hope I'm wrong and you're right but I'm not convinced the market values risk the way we do. What we call risk in retrospect is what makes many people go into specialties like emergency medicine, critical care, and trauma surgery. It attracts people who want to save lives and deal with life or death decisions. By the time we get to a point in our career where we view it as a risk, we're already residency trained and the barrier to doing something else is too high for most people to pack up and quit. I'd make a similar argument about hours where trainees are attracted by the lower total hours and being able to leave work at work and then "stuck" by the time a 9-5 sounds good. I think the market will find an equilibrium with us a little higher than primary care pay for the area and in doing so we will see primary care physicians pushed out / withdraw from emergency department work as employers don't find the cost savings worthwhile and primary care providers don't find the pay enticing enough for the reasons you mention and the general disposition that attracted them to primary care in the first place.
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Psych is definitely a fantastic field for the right physician. There is excellent ability to achieve some degree of autonomy via PP.
Alternatively you can work for a hospital traditional inpatient/outpatient, CL, addiction, etc...For those that love the ED environment/shiftwork, EM psych as a stand alone job is growing a bit to my understanding. Not the perfect fit for me personally, but a great option for many nonetheless!
Alternatively you can work for a hospital traditional inpatient/outpatient, CL, addiction, etc...For those that love the ED environment/shiftwork, EM psych as a stand alone job is growing a bit to my understanding. Not the perfect fit for me personally, but a great option for many nonetheless!
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Yea we have a few attendings at my residency that work dedicated EM-psych shifts at an affiliated inpatient facility. For the right personality it seems to be a great gig.
The EP sees and does the initial psychiatric eval and starts meds, evaluates and initially treats the patient’s co-existing medical issues (like pneumonia or CHF off meds). We see a lot of substance abuse so they manage the withdrawal cocktail for the first 24ish hrs.
You just have to be legitimately interested in the nuances of treating psychiatric emergencies. Obviously most EPs do that type of work by compulsion rather than because they like it, but for the subset That enjoy it it’s a nice, slower paced set-up.
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Alot of terrible advice on this thread. To go back and do another 3-5 yr of residency just b/c things are good now? All specialties changes.
You could easily go into Psych, spend another 3 yrs in residency, and have Psych be in the same boat as EM. This goes for all fields.
Go do EM b/c you like it. You Will find a job that pays 3-400K/yr. Pay off your debt so you can do whatever you want in 10 yrs.
You will likely regret going back to doing another residency.
You could easily go into Psych, spend another 3 yrs in residency, and have Psych be in the same boat as EM. This goes for all fields.
Go do EM b/c you like it. You Will find a job that pays 3-400K/yr. Pay off your debt so you can do whatever you want in 10 yrs.
You will likely regret going back to doing another residency.
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This is partially true.
If you're just fishing for a field to make more $, then it doesn't make sense to go back and do a 2nd residency. Stay in EM or exit clinical work.
However, if you're looking to be your own master and have work:life balance than going back and doing something like psych (or any other field with the potential to hang your own shingle) makes perfect sense. You just have to actually like the practice of psych or whatever the other field is.
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There are risks with opening your own practice. Anyone concerned about paying down their school debt likely do not have the stomach to Take out a big loan opening their own practice without any guarantees. There are a reason why most specialists and PCP docs are joining a large group/hospital practice and not opening up a brand new pratice.
Even with EM, you could open up an Urgent care and hire NPs that does well.
Even with EM, you could open up an Urgent care and hire NPs that does well.
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Who is saying there is no risk? Of course there's risk...as with any business.
Aren't you an owner of a freestanding ED? Would you undo your investment if given the chance or was the risk worth it?
The reality is that a solo psych practice can be opened for minimal $. A surgical subspecialist can start out on the cheap as well by renting a room at a pcp practice a few days a week and operating on the others (and it costs them nothing to do their cases at a hospital or surgicenter who will welcome them with open arms).
Nobody is saying every practice will be a slam dunk let alone be successful...but if you look around you'll see enough creative ways to start small and scale up as you go.
Even if somebody in an outpatient field doesn't choose to hang their own shingle, just having the option to do so gives them a little bit more negotiating power with hospitals...especially when it's time to renegotiate.
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I think most people's pay is going to approximate hospitalist salaries (likely via cross-subsidization from CMGs or a rebalancing of payments based on ACOs for hospital-employed docs). We'll continue to make a little more hourly, but overall salaries will be about the same.
There's going to continue to be downward pressure on pay from gov't and insurance, but corporate overlords will continue to extract their pound of flesh. The coming oversupply (or close to it) of graduating residents will ensure that hospital subsidiaries become a thing of the past. CMGs need to maintain their margins, they'll do so via a combination of increased midlevel supervision and decreased pay. Denver Usuck pay will be the norm in any city CMG gig.
Some this is simply reversion to the mean. I mean, when I applied for residency I thought EM docs were making the same as non-procedural IM specialists, like 220k or so per year. I was pleasantly surprised with my first job, which paid 300k.
Part of the issue is that the practice of emergency medicine may eventually become unrecognizable. Want to spend your time intubating people, reducing dislocations and reassuring nervous patients about their complaints while picking up the rare case of actual pathology? I do, and that's why I went into this field. I'm not sure whether this will exist in the future. Patient is sick? Call a Critical Care alert and the ICU NP will be right down. Your talents are better put to use chasing down patients in the WR to reduce LWBS rates and signing off on 8-12 midlevel charts/hr.
SDGs will fare better. Pay decreases will only be dependent on decreased reimbursement and loss of hospital subsidies. So maybe a 10% inflation adjusted reduction in pay and day to day practice can be maintained. But good luck finding them.
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Guys, I love you. I really do. I know we are in a sad state of affairs, but some of the things I am reading in this thread are pretty idiotic.
Open up a FM practice? Pediatrics? Is that a joke? Where in this country are primary care docs in private practice raking in money? Running your own primary care practice is one of the least lucrative and highest stress endeavors I can think of. You eat what you kill, and if you can't pay the bills, you go under or get bought out. Also, I have seen jobs for pediatric hospitalists in desirable cities on the coasts offering sub 100K salaries. Let that sink in for a second.
EM/CCM really looks sexy purely from a grass is greener perspective. Intensivists are having a hard time finding jobs. Midlevel expansion is happening in the CCM world as well. Tele-ICU is even more prominent. It's not all that it's cracked up to be.
As has been beaten to death in this forum several times, other specialties are getting obliterated just as much, if not more than EM is right now. I fully agree, things are not great, but the "sky is falling so bad that you should become a pediatrician" is a bit of an overreaction.
Open up a FM practice? Pediatrics? Is that a joke? Where in this country are primary care docs in private practice raking in money? Running your own primary care practice is one of the least lucrative and highest stress endeavors I can think of. You eat what you kill, and if you can't pay the bills, you go under or get bought out. Also, I have seen jobs for pediatric hospitalists in desirable cities on the coasts offering sub 100K salaries. Let that sink in for a second.
EM/CCM really looks sexy purely from a grass is greener perspective. Intensivists are having a hard time finding jobs. Midlevel expansion is happening in the CCM world as well. Tele-ICU is even more prominent. It's not all that it's cracked up to be.
As has been beaten to death in this forum several times, other specialties are getting obliterated just as much, if not more than EM is right now. I fully agree, things are not great, but the "sky is falling so bad that you should become a pediatrician" is a bit of an overreaction.
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Dude you have to talk to patients in psych. That's the worst.
Yeah I wouldn’t fool yourself into thinking like this. A mentality of “my job is harder than this other type of job so we will always be paid more” isn’t a rule in real life.
A great example: the UK
ER docs there get LESS for locums in an undesirable region, than general medicine for locums in a desirable location (London).
£85-105/hr for ER in a bad area vs £100-125/hr for gen med in a good area.
Opportunity for Consultant in Accident and Emergency – ASAP £85 - £105 /hr in Scotland - Medecho
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Oh and it isn’t ER that gets the top locums pay per hour either. Locum pay since the cap
The point here is that you are at the mercy of society, which supersedes market forces.In reality, if enough selfish Americans desire ‘free’ medical care for all, they can vote in a government that will essentially slash full time ER pay to equal that of primary care in the process and your feelings will have no say in the matter.
How to Increase Your Family Medicine Physician Salary | White Coat Investor
Here's how top physician earners in typically lower-income specialties are killing it and commanding over 2X+ the average for their specialty.
www.whitecoatinvestor.com
“Our first volunteer is Mike, a pediatrician who made $430,000 (>2X the average above) in 2018. He averages eight to nine hours a day, four days a week, 50 weeks a year.”
“Our second volunteer wishes to remain anonymous, but is also a primary care pediatrician who makes $450,000 working 32 hours per week over 4 days and 47 weeks a year. He also takes call 4-5 times a month.”
“This anonymous family practitioner came out of residency in 2016 owing $375K in student loans. He is an employee of a 501(c)3 hospital and made $343K in 2018 and expects to make $415K in 2019 working 42 hours per week over 4 days and refuses to sign into his EMR on his weekday off.”
“Dr. Solo” is a med-peds doc who made $500,000 in 2018 working 35-40 hours/week, 45 weeks/year. He is “always on call” with the solo practice he owns but never goes to the hospital. Call is about 3 after-hours calls per month.
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It isn’t a machismo argument, it is 110% correct that ER work, on average, is orders of magnitudes harder and stressful than general med or hospitalist or whatever other work per hour.
ER should pay more.
What I am pointing out is that no one should make the assumption that “should” always translates to “it does” in reality. The future pay for EM can easily spiral downwards to match those of other less demanding specialties at the whim of politicians and eager voting masses chomping at the bit for “free” everything.
And I suspect the majority of newer ER attendings don’t have the luxury to quit and do something else if that does occur. It’s why garbage paid ER work in the UK still retains many docs
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Very curious about the people saying how the downfall of EM is only cyclical and will recover without expanding on that notion. The oversupply of EM physicians started long before COVID. There is no way on earth that any of the current residencies open are going to close. It doesn't even appear that expansion is slowing down. Looking through jobs over the past couple weeks, I'm still seeing recruitment for "Residency Program Director" in some bum **** essentially rural places across the board.
Do you think a bunch of hospitals are going to be built (Numbers show they're actually closing in record numbers, precovid)? FSEDs going to reign again? Urgent care is long dead from all the low-level providers trying their best to kill patients. We can't do PP. CCM is saturating fast as noted previously from teledocs, LLPs, people that saw the saturation of EM awhile ago, etc. Using tox won't happen. US/wilderness/simulation/admin/etc is a joke and delays the inevitable by a year. Dozens of new yearly residencies with RRC, ACEP, ABEM silent.
While I do agree that switching to FM or Peds is terrible advice, but if you're a medical student it's not a bad idea to consider. Using pay/salary as market outlook is the wrong idea. First, will be the loss of positions (now). Salaries in EM will say "decent" as nothing becomes available and jobs completely dry up, then places will drop their current EPs when they realize that new grads are dying for jobs and will take anything. New grads can sign off on LLP charts all the same. Why keep an EP at 225-250hr when they can snag a new grad at 150-175? Reimbursement isn't going to change. Essentially more free money for that CMG/employer. We know probably the best that hospitals/employers/CMGs don't care about you at all. I'm not sure why people think this won't happen. I guess EM docs are just waiting for it to happen before they actually think there's a supply issue.
Do you think a bunch of hospitals are going to be built (Numbers show they're actually closing in record numbers, precovid)? FSEDs going to reign again? Urgent care is long dead from all the low-level providers trying their best to kill patients. We can't do PP. CCM is saturating fast as noted previously from teledocs, LLPs, people that saw the saturation of EM awhile ago, etc. Using tox won't happen. US/wilderness/simulation/admin/etc is a joke and delays the inevitable by a year. Dozens of new yearly residencies with RRC, ACEP, ABEM silent.
While I do agree that switching to FM or Peds is terrible advice, but if you're a medical student it's not a bad idea to consider. Using pay/salary as market outlook is the wrong idea. First, will be the loss of positions (now). Salaries in EM will say "decent" as nothing becomes available and jobs completely dry up, then places will drop their current EPs when they realize that new grads are dying for jobs and will take anything. New grads can sign off on LLP charts all the same. Why keep an EP at 225-250hr when they can snag a new grad at 150-175? Reimbursement isn't going to change. Essentially more free money for that CMG/employer. We know probably the best that hospitals/employers/CMGs don't care about you at all. I'm not sure why people think this won't happen. I guess EM docs are just waiting for it to happen before they actually think there's a supply issue.
This right here. There’s no mechanism for EM to have a cyclical recovery. We have a systemic oversupply problem. Ask pharmacists when their recovery is coming after the boom days of the 2000s.
