We now have a total of 60 new EM residency programs

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CCM-MD said:
$300/h for hospitalist is an outlier, not the norm. You frequently post this comparisons of the equivalent of >90th percentile hospitalist to average/low numbers for other specialties. I also believe you posted screenshots of your investment accounts. Kind of weird. Wonder if its an inferiority complex thing if you feel the constant need to post your financial successes on here. Regardless, hospitalist is not "safe" by any means, very saturated in my area, 120-140/h for days is the average.
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I am flattered. Jealousy does come in many forms and expressions!
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sallyhasanidea said:
Where do you live?

Any suggestions/thoughts on EM vs. IM regarding job market and what are your thoughts on the future of midlevels in IM? Will we see a situation IM where midlevels are hired more, less need for physician oversite, leading to saturation of hospitalist and primary care positions?
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Hospitalist PA/NP were all terminated at a hospital system near ours couple years back. They could not justify the cost of paying them /they could not prove they significantly improved efficiency vs just having hospitalist physician team only. At my current job we have NP only for night crosscover.

at my first year job, as an academic hospitalist we had zero np/pa at any of the hospitals we could work at

I can’t speak much to primary care but only from my limited experience as a hospitalist. I don’t think midlevel encroachment has been a problem thus far
 
wamcp said:
I am flattered. Jealousy does come in many forms and expressions!
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:D


Also:
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The Knife & Gun Club said:
Add Plantation Florida to the list.

I’m from Plantation. I’ve been to west side medical center. The idea they could train even 1 EM resident a year is laughable.

They don’t have the volume or the acuity, let alone being like the 7th program in south Florida.

So stoked to graduate into the soon-to-be most over-saturdated market in the US. View attachment 318384
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You know, I’m so relieved to hear this. I just had a nightmare that Plantation, population of less than 100k souls, didn’t have it's own EM residency. Thank you HCA and Westside Regional Medical Center for ensuring your powerhouse of a 224 bed hospital provides what will no doubt be a performance-driven education to trainees.

And for heaven's sake, I hope HCA ensures these interns understand the importance of maintaining a sub-10 minute door-to-provider greeting time so it can be displayed on the website and billboards. A 9 min wait time sells itself way more than a 10 min wait when Johnny Johnson is shopping EDs at 2am on a Thursday and needs to get stat care for his asymptomatic but long standing BP of 150/80.

And Westside Regional, please make sure your residents are trained to be extra cautious and how to go the extra mile for patients. So when Mr. Johnson does show up, teach them to immediately call a code stroke (and start the billing clock), move him into a critical care bay, and ensure he gets a total body CTA as well as full labs and serial trops and EKGs. And then when all of that is negative and he still has a normal exam please make sure your folks are taught to give him all the asprins and the heparins. Oh, and make sure your learners show extra kindness and order a stat echo and renal sono. And since there's no sono tech overnight they'd better be taught to admit him for tele obs to have these critically important tests done later in the day.

Oh what's that? Johnny is asking if his insurance will cover the obs admission? Here's where the excellent HCA didactics on "critical conversations" for the residents can come into play. Educate them to coach Johnny though his financial concerns with phrases like "we at HCA Westside Regional Medical Center are solely focused on taking your care to the next level and your acute care needs right now. Let's worry about payment later...but the good news is we have variable interest rate payment plans! Or, you can go home and die, your choice."

And dearest HCA, when Johnny reluctantly agrees to stay, guide your residents down a path of supreme compassion for Johnny and have them straight cath him for ultrastat urine lytes and consult nephro on behalf of the NP hospitalist (whose H&P and admitting orders the ED attending needs to co-sign since it's overnight). Sure, some jealous folks may say this is gratuitous care, but it's literally the foundation that good HCA care and the empire is built on.

And Westside Regional, please make sure your residents are instructed on the proper way to leave an HCA shift: have them turn in their location trackers to their nurse supervisor and bend the knee and kiss her ring on the way out.
 
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EMhawkeye said:
Not a "new" program. Was a DO em program that transitioned to acgme accred
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RustedFox said:
Which?

Doesn't matter.


Never had volume or acuity.
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And that's the thing: It "never had the volume or acuity" but we never said anything because the 'RRC ensures all EM programs meet an adequate standard' or some similar nonsense from many regular and respected posters here. For some reason the 'DO/osteopathic problem' became such a third rail that we all decided to not discuss the facts.

Well, we are all facing the consequences now.

HH
 
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sallyhasanidea said:
Isn't there saturation in IM as well with mid levels taking over primary care and hospitalist positions?
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It’s still very very easy for FM and IM to find jobs in my experience. As far as I’m aware still getting paid pretty well for our fields as well and I think some say salaries are going up. Also, being trained in FM and IM can work in a ton of different environments so not forced to work in just a hospital. Therefore based on reading the EM forums I think our field absolutely does have more NPs and PAs in it, but physicians are still in demand and can find a variety of jobs that pay decently for our fields.

ETA: I’m more familiar with the outpatient side of things than the inpatient side of things. However, I was recently job hunting and saw lots of openings for inpatient, but don’t know their salaries.
 
alpinism said:
For everyone who still believes the EM job market won't be completely saturated within the next few years.

Medical students take note because there likely won't be any good jobs left by the time you graduate residency.


1. Kendall Regional Medical Center - Miami, Florida
2. UM Jackson Memorial Hospital - Miami, Florida
3. FIU Adventura Hospital - Adventura, Florida
4. FAU Delray Medical Center - Delray, Florida
5. Northwest Medical Center - Margate, Florida
6. Ocala Regional Medical Center - Ocala, Florida
7. Osceola Regional Medical Center - Kissimmee, Florida
8. North Florida Regional Medical Center - Gainesville, Florida
9. Orange Park Medical Center - Orange Park, Florida
10. Sarasota Memorial Hospital - Sarasota, Florida
11. Oak Hill Hospital - Brooksville, Florida
12. Lakland Medical Center - Lakeland, Florida
13. Brandon Regional Medical Center - Brandon, Florida
14. Coliseum Health Medical Center - Macon, Georgia
15. Cartersville Medical Center - Cartersville, Georgia
16. Wellstar Kennelstone Hospital - Marietta, Georgia
17. Grand Strand Medical Center - Myrtle Beach, South Carolina
18. Greenville Memorial Hospital - Greenville, South Carolina
19. Trident Medical Center - Charleston, South Carolina
20. Mission Health Medical Center - Asheville, North Carolina
21. UT Nashville Medical Center - Murfreesboro, Tennessee
22. Riverside Regional Medical Center - Newport News, Virginia
23. Lewis Gale Health Medical Center - Salem, Virginia
24. University of South Alabama Hospital - Mobile, Alabama
25. Dothan Regional Medical Center - Dothan, Alabama
26. Oschner Medcial Center - New Orleans, Louisiana
27. Unity Health Medical Center - Searcy, Arkansas
28. BSW All Saints Medical Center - Fort Worth, Texas
29. Medical City Arlington Hospital - Arlington, Texas
30. Texas Tech Medical Center - Lubbock, Texas
31. Kingwood Medical Center - Houston, Texas
32. Las Palmas Medical Center - El Paso, Texas
33. Brookdale Hospital - New York, New York
34. St John Riverside Hospital - Yonkers, New York
35. Orange Regional Medical Center - Middletown, New York
36. Vassar Brothers Medical Center - Poughkeepsie, New York
37. Northwell Southside Hospital - Bayshore, New York
38. Arnot Ogden Medical Center - Elmira, New York
39. Robert Guthrie Medical Center - Sayre, Pennsylvania
40. Einstein Montgomery Hospital - Norristown, Pennsylvania
41. UPMC Pinnacle Hospital - Harrisburg, Pennsylvania
42. Reading Tower Hospital - Reading, Pennsylvania
43. Wyoming Medical Center - Wilkes-Barre, Pennsylvania
44. Nazareth Hospital - Philadelphia, Pennsylvania
45. Crozer Chester Hospital - Upland, Pennsylvania
46. UVM Medical Center- Burlington, Vermont
47. St Ritas Medical Center - Lima, Ohio
48. St Joseph Hospital - Stockton, California
49. Kaiser Modesto Hospital - Modesto, California
50. Eisenhower Hospital - Rancho Mirage, California
51. Los Robles Medical Center- Thousand Oaks, California
52. Desert Regional Medical Center - Palm Springs, California
53. Riverside Community Medical Center - Riverside, California
54. Temecula Valley Medical Center - Temecula, California
55. St Agnes Medical Center - Fresno, California
56. Abrazo Health Medical Center - Phoenix, Arizona
57. Sunrise Health Mountainview Hospital - Las Vegas, Nevada
58. Valley Health Sumerlin Hospital - Las Vegas, Nevada
59. Loyola Medical Center - Chicago, Illinois
60. Rush Medical Center - Chicago, Illinois
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Also maybe I’m a little biased but some of these programs are just not like the others. There’s maybe 10 on this list that have the volume, acuity, and academic resources to be training EM docs.

Wellstar in Georgia is one of the busiest EDs in the US with over 200,000 visits a year.

UT Nash is headed up by Dr Reiter, former AAEM president and one of the major proponents of controlling the residency expansion and pushing back against the CMGs.

UM/Jackson is the largest county hospital in the country, one of the nations busiest trauma centers, and the only academic medical center for a city of 6 million. Again, biased, but ¯\_(ツ)_/¯

I don’t think it’s unreasonable for places like these to get programs. The issue comes with the flood of programs at low acuity community/HCA/CMG shops where you know damn well they will get subpar training.
 
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The Knife & Gun Club said:
Also maybe I’m a little biased but some of these programs are just not like the others. There’s maybe 10 on this list that have the volume, acuity, and academic resources to be training EM docs.

Wellstar in Georgia is one of the busiest EDs in the US with over 200,000 visits a year.

UT Nash is headed up by Dr Reiter, former AAEM president and one of the major proponents of controlling the residency expansion and pushing back against the CMGs.

UM/Jackson is the largest county hospital in the country, one of the nations busiest trauma centers, and the only academic medical center for a city of 6 million. Again, biased, but ¯\_(ツ)_/¯

I don’t think it’s unreasonable for places like these to get programs. The issue comes with the flood of programs at low acuity community/HCA/CMG shops where you know damn well they will get subpar training.
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It’s really UT Murfreesboro though. Lol.

Yeah not every new program is bad. Greenville, SC has a real hospital too etc. The better new programs are at huge hospitals that are largely unopposed by other EM residencies (or have the population density to support the program).

And someone above made the point that a lot of the older, midwestern DO programs are also pretty terrible and shouldn’t have programs either.
 
Dr Mantis Toboggan said:
It’s really UT Murfreesboro though. Lol.

Yeah not every new program is bad. Greenville, SC has a real hospital too etc. The better new programs are at huge hospitals that are largely unopposed by other EM residencies (or have the population density to support the program).

And someone above made the point that a lot of the older, midwestern DO programs are also pretty terrible and shouldn’t have programs either.
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I remember landing at the airport for my UT “Nashville” interview, putting the destination into Maps, and just thinking DAMNIT!
 
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Any hospital that does have access to a level 2 trauma center in their own hospital or system has no business having a residency. We are shipping out our Envision residents to San Diego because our two local trauma centers are already swamped with residents from the two other programs.
 
A lot of rural DO programs closed because they could not meet ACGME requirements. I do think there is a place for community programs in Emergency Medicine and while I don’t agree with rapid expansion of new programs ****ting on a bunch of programs is not productive for this forum.
 
Buckeye1992 said:
A lot of rural DO programs closed because they could not meet ACGME requirements. I do think there is a place for community programs in Emergency Medicine and while I don’t agree with rapid expansion of new programs ****ting on a bunch of programs is not productive for this forum.
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Nobody disagrees that there's a place for community programs.

I trained at one. We saw >100k per year, were the busiest trauma center in a major city, had an LVAD program and the residency program has been around for decades.

I don't think the new joint ventures between HCA and Hamburger U fit the bill.
 
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So overall, what does this mean for someone who is looking to match into EM in 2028?
 
habbohomer said:
So overall, what does this mean for someone who is looking to match into EM in 2028?
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You'll be working at McDonalds and Starbucks to supplement your salary from your 1 shift a month you can do at a rural urgent care where you present to an NP to sign off on your chart.
 
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habbohomer said:
I'm just trying to understand peoples opinions. Very vague responses all over this thread.
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That's understandable, I'll expand.

This forum contains a number of posters with strongly asserted but quite disparate opinions on medicine. We're also semi-anonymous and don't know you well enough to give you usefully individualized advice. Add to that the fact that things are in flux and you've got 8 years for both the world and you to change --> this thread/forum is more likely to just give you anxiety or false hope than it is to give you reliable, actionable advice on how you should plan your future nearly a decade hence.

So, I'll give you the (somewhat vague but absolutely sincere) advice I give to EM hopefulls I meet in real life (not just med students):

If you can see yourself happy doing anything other than EM, do it. If you can't, then welcome to the club.
 
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habbohomer said:
I'm just trying to understand peoples opinions. Very vague responses all over this thread.
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Wilco gave really good advice. If you can do anything else besides EM, do it. Essentially every other specialty has a better job outlook except maybe rad/onc. Even path is recovering since they're all 90 years old and retiring soon.

Some boomers on here and elsewhere that have had a unicorn/stable job for 10 years will tell you the market is fine, but it's not. Unless places start building hospitals left and right the market is only going to get more dire year by year on an exponential scale since most of these residencies are new and just now graduating all these classes within the past 1-2 years and next couple years.
 
Job market is bad.
Pay is going down.
Hours are cut for good.
Sign on bonuses are gone for the most part.
Saturated city markets are leading to saturation outside the city.
Locums are drying up.
Increasing supply (new residents) with decreasing demand (decreasing physician coverage).

This is an Emergency Medicine recession.

Dig in for lean years to come. It is time we all get use to the prospect incomes are going from $350-450k to $250-$350k or even less. Sad part is that it will mean making less and working harder because physician coverage is going to be less.
 
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Yea talking to people in Florida most places in my metro are offering around 200-300k for 14 shifts/month. We’re ground 0 for the CMG expansion and I’d expect this to spread with time.

There are SDGs (my program is affiliated with one) where people make more, but those jobs are tough to come by.
 
Rekt said:
Wilco gave really good advice. If you can do anything else besides EM, do it. Essentially every other specialty has a better job outlook except maybe rad/onc. Even path is recovering since they're all 90 years old and retiring soon.

Some boomers on here and elsewhere that have had a unicorn/stable job for 10 years will tell you the market is fine, but it's not. Unless places start building hospitals left and right the market is only going to get more dire year by year on an exponential scale since most of these residencies are new and just now graduating all these classes within the past 1-2 years and next couple years.
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I mean, even in bad markets y'all still make more than the other 3 year residency specialties generally speaking.

But we don't have the 24/7 shift coverage or the endless flow of BS mixed in with legitimate sick people.
 
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The Knife & Gun Club said:
Yea talking to people in Florida most places in my metro are offering around 200-300k for 14 shifts/month. We’re ground 0 for the CMG expansion and I’d expect this to spread with time.

There are SDGs (my program is affiliated with one) where people make more, but those jobs are tough to come by.
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This is why I favored programs run by democratic groups when I applied. Several grads from last year's class joined the group. When the pandemic hit all of their jobs were protected. It's nice to have a work environment that supports its partners and its residents. I'll plan to stay on after training if given the opportunity. This is in a fairly desirable area as well.
 
Torsion said:
This is why I favored programs run by democratic groups when I applied. Several grads from last year's class joined the group. When the pandemic hit all of their jobs were protected. It's nice to have a work environment that supports its partners and its residents. I'll plan to stay on after training if given the opportunity. This is in a fairly desirable area as well.
Click to expand...

Good luck with the spot.
 
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VA Hopeful Dr said:
I mean, even in bad markets y'all still make more than the other 3 year residency specialties generally speaking.

But we don't have the 24/7 shift coverage or the endless flow of BS mixed in with legitimate sick people.
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sure I think most us would happily take care of only legitimate emergencies while sleeping the rest of the time at night for 1/2 the pay. but that’s not reality.
 
The other thing people don’t realize is that with every new program you also lose attending jobs.

Instead of staffing multiple attendings they can staff a single attending with multiple residents.
 
alpinism said:
The other thing people don’t realize is that with every new program you also lose attending jobs.

Instead of staffing multiple attendings they can staff a single attending with multiple residents.
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yes and no

One of those programs on there I recognize. They're going to lay off all the midlevels and replace them with residents. Cheaper!
 
I’ve been out for several years never did em FT as I’m pain trained. It went from incessant non stop calls with recruiters to nothing. All my per diems dried up and now that I’m starting to get some locums emails - well these are from this last week :

I asked about rate - replies:

“I’m sorry, I hope I didn’t offend you. I know the rate is quite low. Glad you are not desperate, though. Many providers around the country are suffering tremendously.”

Another locums oppprrunity they presented to me -

“
I heard back from *** turns out they went with another provider for a lower rate for their open ER shifts.
I appreciate your willingness to help out
“


EM is dead.
 
The Knife & Gun Club said:
Yea talking to people in Florida most places in my metro are offering around 200-300k for 14 shifts/month. We’re ground 0 for the CMG expansion and I’d expect this to spread with time.
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Shift length? I'm not looking for a job, but it drives me crazy when people post info like this without shift length. The job you described at 8 or 9hrs/shift is vastly different than the same gig with 12s.

300k for 14 8s isn't a bad deal. Not great for sure, but not bad. Whereas 200k for 14 12s is a PA job
 
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@BoardingDoc

You're right-on. The dumpster fire that I just left was a mix of 9's and 10's x 14-16 shifts a month for around 300K.

I just (two minutes ago) got off the phone with one of my buddies who still works security/facilities management at DumpsterFire Hospital.

He said to me: "Duuuude. Be glad you got out when you did. The turnover is stunning."
 
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Rekt said:
Exactly. You're going to be fighting with 90% of your colleagues for these spots. They aren't dumb.
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Any good job is likely to be a competitive job almost by definition. I think you'd be surprised, though. I'll likely compete against some of my colleagues but a lot of my co-residents have many other factors which might lead them away from here in 3 years. Some have SOs in other states that they plan to rejoin. Others have a rabid affinity for their home states and plan to move back. Others have lived in this city their entire lives and want to explore before settling down. Others want to move to the beach. There are a lot of factors that would go into making a decision about where to take a first job. I don't have any of these attachments right now and my first priorty can be finding the best possible job. That could easily change if my personal life changes, though. Also, many residents don't really know the business and politics of medicine, don't know what an SDG is, don't know what a CMG is, and don't understand the value of a partnership over an employed or contracted model.
 
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BoardingDoc said:
Shift length? I'm not looking for a job, but it drives me crazy when people post info like this without shift length. The job you described at 8 or 9hrs/shift is vastly different than the same gig with 12s.

300k for 14 8s isn't a bad deal. Not great for sure, but not bad. Whereas 200k for 14 12s is a PA job
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Sorry.

10s, ~14 shifts per month.
 
Fox800 said:
200-300k for 140 hours a month is not a good deal.

I made 350k + retirement matching + CME working 144hrs a month in Austin as a brand-new doc. Those hours are excessive (12x12s) but you get the picture.
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When was this, historically?
 
Precovid- 12, 12 hr shifts = ~$414,000

Post COVID- 14, mix of 9 and 10 hr shifts = ~$377,000

Patient volumes are stabilized (although less than precovid). Patient volumes will spike and seeing 3-4 patients per hour for 4-6 hours in a row. Rumor of plans to go single coverage physician ED with pre-COVID mid level hours.

This means 2 full time physicians have to leave, and if going to single coverage physician plan then 3 full time physicians have to leave.

No new hospitals being built in the area.
 
Porfirio said:
Precovid- 12, 12 hr shifts = ~$414,000

Post COVID- 14, mix of 9 and 10 hr shifts = ~$377,000

Patient volumes are stabilized (although less than precovid). Patient volumes will spike and seeing 3-4 patients per hour for 4-6 hours in a row. Rumor of plans to go single coverage physician ED with pre-COVID mid level hours.

This means 2 full time physicians have to leave, and if going to single coverage physician plan then 3 full time physicians have to leave.

No new hospitals being built in the area.
Click to expand...

Patient volumes will return in time, and likely continue their increase. Volumes are still down due to the general terror level in the population from watching CNN.
 
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GeneralVeers said:
Patient volumes will return in time, and likely continue their increase. Volumes are still down due to the general terror level in the population from watching CNN.
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At what point do you say this is the new norm? Just curious. Have you picked a date?
 
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xaelia said:
Well, one good way to get overseas is to get FACEM ... and we're still taking refugees, here:

Job expired - CDHB

PhoenixATS
cdhb.careercentre.net.nz
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I am very interested in this pathway. COVID is making it difficult even getting BCEM status however. Oral boards canceled indefinitely. I'm sure they'll move it to Zoom and charge just as much, but it's going to set me back by a year. Boo.
 
habbohomer said:
I'm just trying to understand peoples opinions. Very vague responses all over this thread.
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Throughout the history of Medicine, these things are often cyclical. The state of things now, do not necessarily predict the state in 2028.
 
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Is there really anything that can be done to stop the expansion though? Or at least make residency training requirements for sites more stringent so random small CMG run departments can't make their own training site? Are any of our governing bodies doing anything?
 
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