The rural job myth

[EctopicFetus]

Job market is royally screwed and I dont see anything in the near or long term future to think it will be better.

NPs, flat national ED visits, folding of FSEDs, telehealth, increasing number of residents every year.

The only thing we have going for us is that population is aging and older people use the ED more. Of course COVID killed off a fairy umber of older people.

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[DocEspana]

Job market is royally screwed and I dont see anything in the near or long term future to think it will be better.

NPs, flat national ED visits, folding of FSEDs, telehealth, increasing number of residents every year.

The only thing we have going for us is that population is aging and older people use the ED more. Of course COVID killed off a fairy umber of older people.

There is always the option of going to war against the (institutions propping up independent practice of) NPs. Just start a downright dirty PR campaign showing they lead to more waste/debility/death. Maybe not even ethical, but a lot of the data they use is flat unethical given how grossly it misrepresents the numbers and facts of their own study. So....

just sayin....

I'm good at designing pamphlets and mailers.

 

[bravotwozero]

ACEP and AAEM should push for more states to open up FSEDs. That's not a permanent solution, but it's something, would at least result in more available jobs.

 

[Rekt]

ACEP and AAEM should push for more states to open up FSEDs. That's not a permanent solution, but it's something, would at least result in more available jobs.

I think the micro hospital model will be more likely than more FSEDs, but it won't even put a dent in the problem (not to mention they seem pretty useless).

 

[EctopicFetus]

I think the micro hospital model will be more likely than more FSEDs, but it won't even put a dent in the problem (not to mention they seem pretty useless).

FSEDs can be owned by docs.. micro hospitals cant.

 

[EctopicFetus]

There is always the option of going to war against the (institutions propping up independent practice of) NPs. Just start a downright dirty PR campaign showing they lead to more waste/debility/death. Maybe not even ethical, but a lot of the data they use is flat unethical given how grossly it misrepresents the numbers and facts of their own study. So....

just sayin....

I'm good at designing pamphlets and mailers.

AAEM put out that anti MLP stuff. I dont know if people on here are members of PPP. That group is a little crazy but very anti MLP and 100% anti FPA. The issue is who is gonna run the PR campaign? Wont be ACEP they have their mouth on the CMG teat. AAEM has no money and I dont think they want to pick a fight outside of the anti CMG thing. They will stand up for docs but thats not the same as being anti MLP.

 

[Angry Birds]

This is a depressing thread. I'm hoping that this turns around after covid goes away.

 

[RustedFox]

This is a depressing thread. I'm hoping that this turns around after covid goes away.

It won't.

EDIT: Post deleted because cancel culture.

 

[bravotwozero]

This is a depressing thread. I'm hoping that this turns around after covid goes away.

Thread? more like depressing forum. Yet I keep coming here again and again, to read and worry about problems that I have no control over. Hmm..

 

[MechEDoc]

Ultimately, I believe this will eliminate EM as a specialty because with these changes what is special about us?

I think this is the problem. No one cares about improved outcomes, better workups, etc. We have failed to ensure that emergency medicine is provided only by emergency medicine physicians. No hospital has FM/IM/Peds cover pathology, etc. But they'll plug an unqualified NP into any slot and start billing.

 

[MechEDoc]

On a more cheery note, I looked at available jobs with TeamHealth and we've got this gem for an assistant program director at a new EM residency in Utica NY!

Job No Longer Exists - TeamHealth

We're sorry, this job no longer exists. Don't worry, we're sure we can find another great opportunity that's perfect for you.

www.teamhealth.com

From Wikepedia...
"Like other Rust Belt cities, Utica underwent an economic downturn beginning in the mid-20th century. The downturn consisted of industrial decline due to offshoring and the closure of textile mills, population loss caused by the relocation of jobs and businesses to suburbs and to Syracuse, and poverty associated with socioeconomic stress and a depressed tax base. "

I've heard that the Mohawk Valley Health System, nee Our Dear Lady of Neglect and Decubitus Ulcers really is poised to turn out some great "providers"!

 

[emergentmd]

maybe I am just completely head in the sand but I can't imagine a ABEM doc being unemployed. If they are not severely region restricted, there are jobs out there.

Am I missing something?

 

[RustedFox]

Believe it. I know several.

 

[dudeliness]

Getting ready to graduate residency and who would have thought I’d actually be grateful to have a job with the Air Force even with the low pay and low acuity.
For those somehow wondering if the job market really is that bad, yes it is.

 

[MechEDoc]

Getting ready to graduate residency and who would have thought I’d actually be grateful to have a job with the Air Force even with the low pay and low acuity.
For those somehow wondering if the job market really is that bad, yes it is.

How are your classmates faring? Also, are you at a newer residency that everyone loves to rip on or a more established program? Times have sure changed since I graduated... I had some shifts making $530/hr within 3 months of graduation and I turned down even more shifts at that rate!

 

[sylvanthus]

Im afraid things are gonna get worse. The powersthatbe know we have few options, so we will just bend over and take it because we have to pay off our loans. The obsession with metrics and press ganey is bound to get worse. Calling it now if it hasnt been called already, docs with lower scores are gonna be let go cuz they know they can fill the spots.

EM docs are gonna be paranoid, groveling ass kissers so they keep their jobs.

Good lord its depressing.

 

[Rekt]

On a more cheery note, I looked at available jobs with TeamHealth and we've got this gem for an assistant program director at a new EM residency in Utica NY!

Job No Longer Exists - TeamHealth

We're sorry, this job no longer exists. Don't worry, we're sure we can find another great opportunity that's perfect for you.

www.teamhealth.com

From Wikepedia...
"Like other Rust Belt cities, Utica underwent an economic downturn beginning in the mid-20th century. The downturn consisted of industrial decline due to offshoring and the closure of textile mills, population loss caused by the relocation of jobs and businesses to suburbs and to Syracuse, and poverty associated with socioeconomic stress and a depressed tax base. "

I've heard that the Mohawk Valley Health System, nee Our Dear Lady of Neglect and Decubitus Ulcers really is poised to turn out some great "providers"!

As I'm looking for jobs there's PDs jobs I've see for;

HCA El Paso
HCA Asheville
TeamHealth NC
CMG in LA area CA
One other I couldn't remember

That's also after 4-5 new programs were approved 2020-2021 already.

 

[bravotwozero]

As I'm looking for jobs there's PDs jobs I've see for;

HCA El Paso
HCA Asheville
TeamHealth NC
CMG in LA area CA
One other I couldn't remember

That's also after 4-5 new programs were approved 2020-2021 already.

Come over to the dark side man. If you can't beat 'em, join 'em....

 

[Rekt]

Come over to the dark side man. If you can't beat 'em, join 'em....

Nothing darker than me opening my eyes every morning feeling like I just wasted the first third of my life.

 

[sylvanthus]

I drove by a small farm in town, they have a meadery, are growing produce, have apple trees, sheep, etc. Just a small hobby farm but looks amazing. I was envious of these people. Simple, satisfying, faaaaarrrr less BS, I chose the wrong path in life.

 

[wamcp]

Im afraid things are gonna get worse. The powersthatbe know we have few options, so we will just bend over and take it because we have to pay off our loans. The obsession with metrics and press ganey is bound to get worse. Calling it now if it hasnt been called already, docs with lower scores are gonna be let go cuz they know they can fill the spots.

EM docs are gonna be paranoid, groveling ass kissers so they keep their jobs.

Good lord its depressing.

Out of curiosity I just looked on practicelink. There are 478 EM physician listings...versus 2177 FM physician, 1219 internal med, 839 hospitalist, 788 psychiatry, 657 obgyn, 646 neurologist, 545 gastroenterologist job listings.

how can this be? One internal med subspecialty has more job listings than all of EM across the country?

 

[RustedFox]

A lot of those links on Practicelink are for spots that are old, don't exist, or are already filled but won't be delisted until the applicant has completed credentialing.

 

[sylvanthus]

Ya know way there are actually 478 jobs available.

 

[GatorCHOMPions]

Ya know way there are actually 478 jobs available.

The proportion of jobs relative to others is probably still valid, though. A popular counterargument to the increasing EM spots is that all generalist specialties (IM, peds, OB, Anes) are increasing. What’s unique about EM is all our spots will be feeding the same job pool - work in an ER. Our fellowships don’t significantly change the opportunities.

 

[namethatsmell]

Out of curiosity I just looked on practicelink. There are 478 EM physician listings...versus 2177 FM physician, 1219 internal med, 839 hospitalist, 788 psychiatry, 657 obgyn, 646 neurologist, 545 gastroenterologist job listings.

how can this be? One internal med subspecialty has more job listings than all of EM across the country?

While obviously the current EM market is abysmal, at least FM and IM have good job markets and their pay is starting to rise appropriately. After several decades of them getting shat on by specialists, it's nice to see pcp's coming to the negotiating table with a little power.

 

[RustedFox]

Ya know way there are actually 478 jobs available.

When I joined SDN ten some years ago, the joke made about getting a job in EM was: "present left or right wrist for pulse check; you're hired".
It was a good joke, because good jokes have a kernel of truth at their core.
Now, what little EM jobs exist, are trash that are not worth the frustration.

When I was an MS-4 in the match, you needed a "backup specialty" to apply to EM, because PGY-1 positions were few.
I rolled the dice harder than my peers, and never chose a backup specialty. Here I am.

My "first class" had 8 PGY-1 slots, and that was pushing it for the program, which was University based. Rumor was they were going to cut back to six before the match.
Now, there's 12 PGY-1 slots at D!ckwater Community General Hospital with 180 hospital beds, and they need a program director.

When I was an attending, in my first year out, I was often paid 2000 dollar 'shift bonuses' to simply pick up a shift that I wasn't scheduled for.
Now, rates are diving all over and first-year attendings are happy to take 150 an hour IC pay and fly home to see their families when they can.

Here's the uncomfortable truth:

EM was a false economy from the start, and the bubble has now burst.
COVID-19 "unmasked" the truth; that 75%+ of EM visits are total nonsense - but hey! Admins can get paid for the volume that they turn and burn by cracking the whip harder on we galley slaves. Forget about the medicine, or doing the right thing. Profits, profits, profits. That stock price needs to go up.

Then, COVID happened, and America stopped using the ER for every little thing. Even when they DID come, I hated looking at their fat, stupid faces. "The number one cause of burnout is: the patient."

The PLP explosion happened "because tests N schools R hard; but shopping for white coats online is FUN. Look! I'm healthcaring! I'm ESSENTIAL AF. FrontLINE WaRRIOr!!1!1! Post it on IG."

I still care about the medicine. Its my mission, so to speak. No PLP can do what I can do, or has even close to my ability to master material from page 1 on up like I can.

I don't have kids or a family to pour time, money, and other resources into. "Wandering Samurai" if you want.

2 years ago, I wrote on here: "I've gone full Veers and IDGAF anymore."
Now, I'm writing this:

"I'm going full Birdstrike."

 

[namethatsmell]

When I joined SDN ten some years ago, the joke made about getting a job in EM was: "present left or right wrist for pulse check; you're hired".
It was a good joke, because good jokes have a kernel of truth at their core.
Now, what little EM jobs exist, are trash that are not worth the frustration.

When I was an MS-4 in the match, you needed a "backup specialty" to apply to EM, because PGY-1 positions were few.
I rolled the dice harder than my peers, and never chose a backup specialty. Here I am.

My "first class" had 8 PGY-1 slots, and that was pushing it for the program, which was University based. Rumor was they were going to cut back to six before the match.
Now, there's 12 PGY-1 slots at D!ckwater Community General Hospital with 180 hospital beds, and they need a program director.

When I was an attending, in my first year out, I was often paid 2000 dollar 'shift bonuses' to simply pick up a shift that I wasn't scheduled for.
Now, rates are diving all over and first-year attendings are happy to take 150 an hour IC pay and fly home to see their families when they can.

Here's the uncomfortable truth:

EM was a false economy from the start, and the bubble has now burst.
COVID-19 "unmasked" the truth; that 75%+ of EM visits are total nonsense - but hey! Admins can get paid for the volume that they turn and burn by cracking the whip harder on we galley slaves. Forget about the medicine, or doing the right thing. Profits, profits, profits. That stock price needs to go up.

Then, COVID happened, and America stopped using the ER for every little thing. Even when they DID come, I hated looking at their fat, stupid faces. "The number one cause of burnout is: the patient."

The PLP explosion happened "because tests N schools R hard; but shopping for white coats online is FUN. Look! I'm healthcaring! I'm ESSENTIAL AF. FrontLINE WaRRIOr!!1!1! Post it on IG."

I still care about the medicine. Its my mission, so to speak. No PLP can do what I can do, or has even close to my ability to master material from page 1 on up like I can.

I don't have kids or a family to pour time, money, and other resources into. "Wandering Samurai" if you want.

2 years ago, I wrote on here: "I've gone full Veers and IDGAF anymore."
Now, I'm writing this:

"I'm going full Birdstrike."

Congrats on taking action.

Also, what's a PLP?

 

[RustedFox]

Congrats on taking action.

Also, what's a PLP?

Coined first by Rekt (credit where credit is due): "Pretend-Level-Provider".... so the NP/PA ABC123 crowd.

 

[MechEDoc]

"I'm going full Birdstrike."

So what's your plan? I like "Medicine", but hate "medicine".

 

[Apollyon]

So what's your plan? I like "Medicine", but hate "medicine".

Exactly. The medicine is interesting and engaging. The patients and crap staff suck.

 

[bravotwozero]

Exactly. The medicine is interesting and engaging. The patients and crap staff suck.

Guess we should all become forensic pathologists! Hope you like formaldehyde and dead people...

 

[GeneralVeers]

I think we should all go Birdstrike. I'm actively looking for a way out. Beyond my side gig, I'm looking to develop my own platform.

Should I lose my full time job in the next 6 months, it's likely the end of my clinical career. I'll make sure to point that out to my Director when we have "the talk".

 

[Fox800]

Coined first by Rekt (credit where credit is due): "Pretend-Level-Provider".... so the NP/PA ABC123 crowd.

I prefer LLP - low level provider, because "mid" is a gross compliment to the 3% of clinical hours they get compared to a physician.

 

[RustedFox]

So what's your plan? I like "Medicine", but hate "medicine".

I will publish my plan once it really takes form; but the goal will be to replace 75-80% of EM income with no EM as it currently is meted out in this awful wasteland of corporate fabrications and faux needs.

I like medicine. It can be great as long as non-doctors don't ruin it thru their parasite nonsense. That includes the patients.

 

[EMhawkeye]

As I'm looking for jobs there's PDs jobs I've see for;

HCA El Paso
HCA Asheville
TeamHealth NC
CMG in LA area CA
One other I couldn't remember

That's also after 4-5 new programs were approved 2020-2021 already.

Two programs coming to El Paso
One in Dover De
Thousand oaks ca

 

[Birdstrike]

"I'm going full Birdstrike."

So, that's a thing now? Hmm....

 

[RustedFox]

Two programs coming to El Paso
One in Dover De
Thousand oaks ca

It's insane. Truly insane. There is no way these grads will have jobs.

 

[Birdstrike]

"Mom, Dad. I've been wanting to tell you something for a very long time. Something you might have suspected.

I'm going Birdstrike!"

 

[RustedFox]

So, that's a thing now? Hmm....

It should be.
It is.

Someone once posted "RF you are on the Mt. Rushmore of this forum."

If that's true, then I was the last minute addition and you were carved first.

 

[Birdstrike]

It should be.
It is.

Someone once posted "RF you are on the Mt. Rushmore of this forum."

If that's true, then I was the last minute addition and you were carved first.

Where're our meme-makers when we need them?

 

[RustedFox]

Where's our meme-makers when we need them?

Right?

I nominate the following to be on Mt. SDNmore:

Birdstrike.
GenVeers.
Apollyon.
docB.
Arcan57.
EctopicFetus.

Others that I'm too busy eating pulled pork to type right now.

I'll be that loudmouthed kid working the visitor center/souvenir shop.

 

[EctopicFetus]

maybe I am just completely head in the sand but I can't imagine a ABEM doc being unemployed. If they are not severely region restricted, there are jobs out there.

Am I missing something?

Yes. It’s real.

 

[Apollyon]

If that's true, then I was the last minute addition and you were carved first.

And then he was replaced with a "."

 

[Arcan57]

Ya know way there are actually 478 jobs available.

I’ve got to think the actual number is going to be in flux due to comparatively few new openings due to flat volumes but also likely an accelerated retirement cycle due to stocks riding high and older docs looking at a post-Covid reimbursement and staffing landscape and saying “nope”. The question about how many jobs will need filling is going to depend a lot on how many groups try and cover those retirements in group by increasing shifts/month in an attempt to bolster sliding incomes. My prior group didn’t replace me when I left at the choice of the remaining docs. Groups that have a choice may suck up the pain until after the current match cycle before buckling under the V/Q mismatch between working harder and making less.
Also, shout out to all the RVU only pit docs that haven’t seen a roomed patient that wasn’t actively coding in months and are staying 3-4hrs after their shift hunting down blood results on patients that will spend their entire ED stay and first 1-2 days of their inpatient stay in the lobby. May the goddess of nurse staffing grant you an equinox miracle of a Covid free hospital with all licensed beds having adequate RN and tech coverage.

 

[Birdstrike]

Right?

I nominate the following to be on Mt. SDNmore:

Birdstrike.
GenVeers.
Apollyon.
docB.
Arcan57.
EctopicFetus.

Others that I'm too busy eating pulled pork to type right now.

I'll be that loudmouthed kid working the visitor center/souvenir shop.

Dude.

In the 2000's, Rusted Fox was posting here.
In the 2010's, Rusted Fox was posting here.
In the 2020's, Rusted Fox is STILL posting here.

Your head goes on the Mountain, bro!

 

[Arcan57]

Right?

I nominate the following to be on Mt. SDNmore:

Birdstrike.
GenVeers.
Apollyon.
docB.
Arcan57.
EctopicFetus.

Others that I'm too busy eating pulled pork to type right now.

I'll be that loudmouthed kid working the visitor center/souvenir shop.

I got banned from SDN, I doubt they’d put black sheep up on the mount.

 

[RustedFox]

Dude.

In the 2000's, Rusted Fox was posting here.
In the 2010's, Rusted Fox was posting here.
In the 2020's, Rusted Fox is STILL posting here.

Your head goes on the Mountain, bro!

It has been that long.
I opened this account in 2007 when I was an MS3 during matchitis.

 

[GeneralVeers]

I'd add Quinn and McNinja too....

 

[sylvanthus]

Ill be hangin out at the overlook with the bomb ass icecream if its still there.

 

[southerndoc]

I got banned from SDN, I doubt they’d put black sheep up on the mount.

Why did you get banned?