We now have a total of 60 new EM residency programs

[RustedFox]

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?

Stop the RRC from taking bribes from HCA.

---

Members don't see this ad.

 

[Rekt]

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?

The RRC needs to deny any approvals for new programs, but they only determine if a program can meet requirements not actually need of physicians so they just willy nilly approve everything. Need some heat from ABEM saying we have plenty of supply, which will only come after all orgs, mainly ACEP and AAEM publicly state they're against further expansion.

 

[Birdstrike]

Stop the RRC from taking bribes from HCA.

Follow the money.

 

[LostinLift]

Stop the RRC from taking bribes from HCA.

Not just HCA now... is there any way to slow/stop this?

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

 

[turkeyjerky]

Mission is owned by HCA. They've been advertising for that PD job since the spring.

 

[TheComebacKid]

The RRC needs to deny any approvals for new programs, but they only determine if a program can meet requirements not actually need of physicians so they just willy nilly approve everything. Need some heat from ABEM saying we have plenty of supply, which will only come after all orgs, mainly ACEP and AAEM publicly state they're against further expansion.

Wait, you are hoping that ACEP, basically for all intents a purposes an organization that is a subsidiary of TeamHealth, Envision, etc, to come out equivocally and state they they are against Team Health sponsored residency programs? Come again?

That ship has sailed a long time ago. ACEP has proven to be pretty much on the wrong side of this issue, along with others, most notably midlevel expansion. The money that we pay in dues to ACEP goes straight into the pockets of CMGs in some fashion or the other.

Stop. Supporting. ACEP.

 

[cyanide12345678]

St. Rita's?!

Lima, Ohio...


Oh. My. God.

You know, that's a decent sized hospital with decent patient volume.

I transfer patients there when my level 1 shop is full and doesn't have any beds available.

Also, the medical director there at least is a splendid guy, he works a few shifts at my shop. Excellent educator and just a good caring human being.

 

[cyanide12345678]

Wait, you are hoping that ACEP, basically for all intents a purposes an organization that is a subsidiary of TeamHealth, Envision, etc, to come out equivocally and state they they are against Team Health sponsored residency programs? Come again?

That ship has sailed a long time ago. ACEP has proven to be pretty much on the wrong side of this issue, along with others, most notably midlevel expansion. The money that we pay in dues to ACEP goes straight into the pockets of CMGs in some fashion or the other.

Stop. Supporting. ACEP.

I got suckered into supporting acep when my associate PD texted me that he didn't see my name on the list of graduates who are already a part of acep. Yup... Had to sign up i can think of so many better things to do with my money honestly.

The problem is that acep while screwing us on the residency expansion and MLP expansion end, it also protects us on other national issues like reimbursement, balance billing etc. Aaem doesn't have a national voice. Acep has a bigger voice. So a large part of the EM community really supports everything that acep does. Most of these guys take pride in being FACEP. That's $500 I'm not going to spend personally but for now aaem protects us from acep, and acep protects our interests from insurance companies and Congress.

If everyone just stopped supporting acep and supported aaem, things will be better i hope.

 

[RustedFox]

You know, that's a decent sized hospital with decent patient volume.

I transfer patients there when my level 1 shop is full and doesn't have any beds available.

Also, the medical director there at least is a splendid guy, he works a few shifts at my shop. Excellent educator and just a good caring human being.

Been there a lot.
Not much in the way of surrounding civilization.

They must have a HYUUGE "catchment area".
That statement comes with its own set of reservations.

 

[Mad Jack]

These are all brand new, not former AOA? Wow. Psych is doing similar though, we have expanded hundreds of slots in the last few years, it's kind of concerning. There's all this "gotta prep for retirement of the old guard" talk that neglects people practicing psych happily into their 70s and 80s... Hard to plan for the future, just work hard and save hard so that of worst comes to worst you can do something else.

 

[NITRAS]

These are all brand new, not former AOA? Wow. Psych is doing similar though, we have expanded hundreds of slots in the last few years, it's kind of concerning. There's all this "gotta prep for retirement of the old guard" talk that neglects people practicing psych happily into their 70s and 80s... Hard to plan for the future, just work hard and save hard so that of worst comes to worst you can do something else.

So many things to worry about. I try to not worry about things I have no control over. I just make sure and try and be a financially stable and work toward independence. It’s not like it is a question of it the job market will change, but how.

 

[WilcoWorld]

So many things to worry about. I try to not worry about things I have no control over. I just make sure and try and be a financially stable and work toward independence. It’s not like it is a question of it the job market will change, but how.

Yep. Trying to prevent change will always be a loosing battle. Trying to effect the direction of change and your adaptability to it are a different matter.

 

[alpinism]

You know, that's a decent sized hospital with decent patient volume.

I transfer patients there when my level 1 shop is full and doesn't have any beds available.

Also, the medical director there at least is a splendid guy, he works a few shifts at my shop. Excellent educator and just a good caring human being.

He could be the nicest person in the world but he also chose to help destroy the field of emergency medicine for a few extra bucks.

 

[Apollyon]

Yep. Trying to prevent change will always be a loosing battle. Trying to effect the direction of change and your adaptability to it are a different matter.

I think you want "affect" there; I believe you are speaking/writing of modification, not bringing about.

But I only write this because it is you!

 

[WilcoWorld]

I think you want "affect" there; I believe you are speaking/writing of modification, not bringing about.

But I only write this because it is you!

you know me too well, as I typed that I was second guessing myself

 

[deleted1074007]

MS2 here! Sounds like EM glory days are over for now. But its hard to gauge how bad the situation really is. If you could switch specialities, would you? What would you switch into?

 

[bravotwozero]

MS2 here! Sounds like EM glory days are over for now. But its hard to gauge how bad the situation really is. If you could switch specialities, would you? What would you switch into?

Nope, not switching. There can still be a lot of money made in the field. You can still come up with a good saving/investing plan, and become financially independent on a EP's pay. Even if the pay has gone down, you can use your free time to do something else to make up for the lost revenue.

As others have mentioned, switching specialties solely to increase your income is not a good idea.

 

[GeneralVeers]

MS2 here! Sounds like EM glory days are over for now. But its hard to gauge how bad the situation really is. If you could switch specialities, would you? What would you switch into?

Whatever specialty most interests you, and that you can do for a long time. If that's EM, then still do EM. Our pay will likely remain good for awhile yet.

 

[turkeyjerky]

Considering the difficulties of applying to, and then actually completing, a 2nd residency, as well as the time-value of money, no I'm not looking to switch specialties either.

However, if I could go back in time 9 years to my MS4 year, I would absolutely, 100% pick a different field.

I say this as someone who really isn't that burnt out on the actual practice of emergency medicine. But the future is bleak. Very bleak. There is a significant chance that once you finish residency the available jobs will either be extremely low volume sites paying 100 bucks an hour or consist entirely of supervising (read signing the charts of) 4 midlevels at a time, basically serving as a malpractice sponge for a CMG.

 

[RustedFox]

Considering the difficulties of applying to, and then actually completing, a 2nd residency, as well as the time-value of money, no I'm not looking to switch specialties either.

However, if I could go back in time 9 years to my MS4 year, I would absolutely, 100% pick a different field.

I say this as someone who really isn't that burnt out on the actual practice of emergency medicine. But the future is bleak. Very bleak. There is a significant chance that once you finish residency the available jobs will either be extremely low volume sites paying 100 bucks an hour or consist entirely of supervising (read signing the charts of) 4 midlevels at a time, basically serving as a malpractice sponge for a CMG.

Quoted for truth.

Count me in on the "I would have chosen something else" crowd.

 

[Lexdiamondz]

Considering the difficulties of applying to, and then actually completing, a 2nd residency, as well as the time-value of money, no I'm not looking to switch specialties either.

However, if I could go back in time 9 years to my MS4 year, I would absolutely, 100% pick a different field.

I say this as someone who really isn't that burnt out on the actual practice of emergency medicine. But the future is bleak. Very bleak. There is a significant chance that once you finish residency the available jobs will either be extremely low volume sites paying 100 bucks an hour or consist entirely of supervising (read signing the charts of) 4 midlevels at a time, basically serving as a malpractice sponge for a CMG.

As a PGY4 currently on the job hunt i'm inclined to agree. Everyone's hurting right now but I've caught a strong case of "shoulda did anesthesia"

 

[deleted1074007]

As a PGY4 currently on the job hunt i'm inclined to agree. Everyone's hurting right now but I've caught a strong case of "shoulda did anesthesia"

because of an inability to find a job? Thats so rough. I'm so sorry.

 

[deleted1074007]

Considering the difficulties of applying to, and then actually completing, a 2nd residency, as well as the time-value of money, no I'm not looking to switch specialties either.

However, if I could go back in time 9 years to my MS4 year, I would absolutely, 100% pick a different field.

I say this as someone who really isn't that burnt out on the actual practice of emergency medicine. But the future is bleak. Very bleak. There is a significant chance that once you finish residency the available jobs will either be extremely low volume sites paying 100 bucks an hour or consist entirely of supervising (read signing the charts of) 4 midlevels at a time, basically serving as a malpractice sponge for a CMG.

What would you have chosen?

 

[turkeyjerky]

What would you have chosen?

Gas+CC. Maybe urology, but most likely the former.

 

[Cath Up]

Doesn't this

Considering the difficulties of applying to, and then actually completing, a 2nd residency, as well as the time-value of money, no I'm not looking to switch specialties either.

However, if I could go back in time 9 years to my MS4 year, I would absolutely, 100% pick a different field.

I say this as someone who really isn't that burnt out on the actual practice of emergency medicine. But the future is bleak. Very bleak. There is a significant chance that once you finish residency the available jobs will either be extremely low volume sites paying 100 bucks an hour or consist entirely of supervising (read signing the charts of) 4 midlevels at a time, basically serving as a malpractice sponge for a CMG.

describe the issue in this

As a PGY4 currently on the job hunt i'm inclined to agree. Everyone's hurting right now but I've caught a strong case of "shoulda did anesthesia"

I am not aware of pay decreasing or feeling as threatened in gas (don't really know about it much) but the description above sounds like what anesthesiologists already do.

I guess the CC fellowship would help.

 

[HemorrhagicShock]

If I could get a "do-over" I would absolutely pick a different field.

Anesthesia and all it's various subspecialties along with practice environments (cushy surgery center all the way to the ICU, with the pain clinic and perioperative medicine clinics in between). ENT seemed to be a great option as well.

Derm if you had the scores and access to research!

Neurology also seems like a great option allowing one to practice well into their 60s and onwards.

Fears of AI taking over radiology are completely overblown (hard to see this as a student, but as an attending it's clear as day)

Yes, every specialty has its pros and cons, but they all give you options to leave the hospital and avoid EMTALA-bound regulatory-hell environments. I've been reading this website ever since I started down the path of applying to medical school and I regret not listening to the doom and gloom posted back in that day. Much of it (on the EM side of things) has come true and it is accelerating fast.

 

[deleted1074007]

If I could get a "do-over" I would absolutely pick a different field.

Anesthesia and all it's various subspecialties along with practice environments (cushy surgery center all the way to the ICU, with the pain clinic and perioperative medicine clinics in between). ENT seemed to be a great option as well.

Derm if you had the scores and access to research!

Neurology also seems like a great option allowing one to practice well into their 60s and onwards.

Fears of AI taking over radiology are completely overblown (hard to see this as a student, but as an attending it's clear as day)

Yes, every specialty has its pros and cons, but they all give you options to leave the hospital and avoid EMTALA-bound regulatory-hell environments. I've been reading this website ever since I started down the path of applying to medical school and I regret not listening to the doom and gloom posted back in that day. Much of it (on the EM side of things) has come true and it is accelerating fast.

Thanks all! Was very excited for EM rotations. Will keep an open mind either way. And keep what you've said in mind.

 

[NITRAS]

I am not aware of pay decreasing or feeling as threatened in gas (don't really know about it much) but the description above sounds like what anesthesiologists already do.

Then you have not spent much time on the gas forum. EM and gas seem to compete for who complaints most about midlevels Encroaching on their field (not that they don’t have good reason to).

 

[turkeyjerky]

Then you have not spent much time on the gas forum. EM and gas seem to compete for who complaints most about midlevels Encroaching on their field (not that they don’t have good reason to).

Doesn't this



describe the issue in this



I am not aware of pay decreasing or feeling as threatened in gas (don't really know about it much) but the description above sounds like what anesthesiologists already do.

I guess the CC fellowship would help.

Yeah, I should've clarified that I would've wanted to pursue CCM, but via an anesthesiology residency (cause IM doesn't give enough procedural experience).

I lurk on the gas forum once in a while. Job market doesn't seem that bad now. Also, it seems they mostly bitch about CMGs b/c of the associated drop in pay, rather than the rest of the BS we have to deal with.

 

[acetylcholinesterasee]

hi all. a third year who really liked EM (still have to rotate in others though). this is all so unfortunate to hear. would pursuing a fellowship in EM help? would graduating from a "better" residency help? I'd be matching/graduating in 2022

 

[Dr Mantis Toboggan]

hi all. a third year who really liked EM (still have to rotate in others though). this is all so unfortunate to hear. would pursuing a fellowship in EM help? would graduating from a "better" residency help? I'd be matching/graduating in 2022

Pay attention to the experience of the EM class of 2021. From what I hear it’s very very bad for them right now trying to get jobs.

 

[The Knife & Gun Club]

Pay attention to the experience of the EM class of 2021. From what I hear it’s very very bad for them right now trying to get jobs.

Our class of 2020 had a really rough go of it a few months back.

Tons of places pulled contracts or tried to force re-negotiation to a way lower rate. The people who were geographically flexible still did great, but the ones who were limited due to family ties got absolutely shafted.

A good friend from a nearby program a job making $150/hour in SoCal, because as he put it “it was this job or divorce”.

 

[HemorrhagicShock]

I recently spoke with my program director as he reached out to me to see if there were any sites locally to where I am at (I moved out of state from where I did residency because of my wife's job) and his experience with this year's senior class is chilling

They can't find jobs for anybody in any of their desired locations, and even 1-2 hours outside of these geographies! It's dire. It's bad. It's really bad.

The only residents that "feel" secure from what he was telling me were the ones that have chosen to do fellowship, but really all that does is delay the job hunt for a year depending on the chosen fellowship.

I encourage current residents reading this to consider doing a fellowship that will add value to your career.

It's hard to see how a toxicology or wilderness medicine fellowship can augment ones pathway if the goal is community/fulltime clinical practice. Academic practices likely aren't hiring these in large quantity either. Many already have settled faculty for these positions and aren't looking to hire.

I do think ultrasound fellowship might add value still, but this is becoming saturated as well, and generally systems only need one ultrasound trained person for multiple sites. By the time that you choose and complete a fellowship (2-3 years from now) the game might be completely different.

Pediatrics might be a new avenue as some community sites look to build out pediatric programs, however the thought of being a PEM fellowship trained person and doing that as a career make me want to vomit (I say this as a father!)

CCM would be the best choice in my opinion. I think Birdstrike talks about his Pain fellowship, however that also seems like a stretch for many. It would be a complete career change rather than an augmented/dual practice. Also seems insanely competitive with how few applicants from EM that they take yearly. Consider that it will get even more competitive as EM people look for "a way out."

I personally think sports medicine is a dead end because of how much competition there is from midlevels, FM, ortho, and many other ancillary care providers.

Doing an administrative fellowship might be a hard pill to swallow, but if it gets you a job in a system or geography that you desire then that might make it worth it. Largely, however, these fellowships are administrative slave labor for a year without much added value to your CV if the goal is to go elsewhere.

 

[deleted1074007]

If you could go back in time, would you do EM again?

Tell me why I SHOULD still pursue EM

sorry for redundant hijacking,

 

[Frazier]

Our class of 2020 had a really rough go of it a few months back.

Tons of places pulled contracts or tried to force re-negotiation to a way lower rate. The people who were geographically flexible still did great, but the ones who were limited due to family ties got absolutely shafted.

A good friend from a nearby program a job making $150/hour in SoCal, because as he put it “it was this job or divorce”.

One of my co-residents took a similar job in SoCal. Tough market, no doubt.

 

[TheSingularity]

$150 / hr to work in one of the worst tax hell holes

LOL

 

[emergentmd]

I dont see how anesthesiology is any better choice. Its all being gobbled up by CMGS, hospital based, early hours, on call dealing with the same issues as ER. If you think the CMGs won't start opening up residencies, then just wait.

I have a friend who is hospital employed and has more bad than good days.

I would do EM again no doubt when taking into account all 3/4 yr programs. I don't think I had anymore energy doing a 5+ yr residency so hard to compare those as options. 3 yrs is the beauty of ER with still high hourly rates and time off.

Now rate and jobs has been shrinking but that is how ALL supply and demand works and eventually we will get to balance.

 

[TheComebacKid]

I encourage current residents reading this to consider doing a fellowship that will add value to your career.

It's hard to see how a toxicology or wilderness medicine fellowship can augment ones pathway if the goal is community/fulltime clinical practice. Academic practices likely aren't hiring these in large quantity either. Many already have settled faculty for these positions and aren't looking to hire.

I do think ultrasound fellowship might add value still, but this is becoming saturated as well, and generally systems only need one ultrasound trained person for multiple sites. By the time that you choose and complete a fellowship (2-3 years from now) the game might be completely different.

Pediatrics might be a new avenue as some community sites look to build out pediatric programs, however the thought of being a PEM fellowship trained person and doing that as a career make me want to vomit (I say this as a father!)

CCM would be the best choice in my opinion. I think Birdstrike talks about his Pain fellowship, however that also seems like a stretch for many. It would be a complete career change rather than an augmented/dual practice. Also seems insanely competitive with how few applicants from EM that they take yearly. Consider that it will get even more competitive as EM people look for "a way out."

I personally think sports medicine is a dead end because of how much competition there is from midlevels, FM, ortho, and many other ancillary care providers.

Doing an administrative fellowship might be a hard pill to swallow, but if it gets you a job in a system or geography that you desire then that might make it worth it. Largely, however, these fellowships are administrative slave labor for a year without much added value to your CV if the goal is to go elsewhere.

I don't see how doing fellowship adds value for anyone going into community medicine. Why does a private group, or more likely, a CMG care if you did EMS/US/Tox etc? They make money when you see patients and order CT scans, not when you sit on hospital committees or travel to Africa to set up mosquito nets with your MPH from global health fellowship.

Toxicologists are one of the most highly coveted sub specialists within EM. Their fellowship is 2 years, so they are very few of them, and overall a hot commodity at pretty much every academic shop. As stated above, doesn't matter for community medicine, nobody cares.

EMS specific jobs are very hard to come by. Medical directors stay medical directors for decades, and there isn't a lot of turnover. Also, the pay from public service agencies is overall poor, so there isn't much academic buy down unless you have a really unicorn set up and a big time agency gig.

While CCM seems really appealing, I have talked to folks who have had issues. Midlevel creep in CCM is real (NPs/PAs intubating, putting in lines etc) with tele-ICU set ups is potentially going to be the model at a lot of places going forward. Also, the half and half gig in both the ED and ICU is very, very hard to find from what I'm told, however that may change in the future.

Wilderness medicine fellowship basically equates to "How to start a campfire using actual dollar bills" since you are pretty much burning a hole in your pocket for absolutely zero gain forward. The majority of academic programs don't even care about wilderness medicine.

Global health to me seems like a PR campaign for an academic shop. "Look we travel to impoverished countries wearing our white coats from our Ivy league EM departments". I know people do good things in the global health world, but in terms of the marketability for it, it doesn't seem like there's that much need.

Ultrasound may have some utility for a place that wants to set up a QA program where you can bill for images. There's still a lot of radiology turf battles. This is one of the few fellowships that translates a little better into the community environment.

Pain/sports/hyperbaric are super niche for EM docs, and I don't have a general sense of the marketability. Perhaps you get a better lifestyle, but I would assume it comes at some cost (namely that you have to do pain medicine, sorry Birdstrike).

 

[acetylcholinesterasee]

I've been interested in PEM from the getgo, was considering applying to one of the EM/Peds combined, would that be a better idea? or definitely only PEM fellowship would help increase job market for me? I've been interested in it but not necessarily enough to warrant 2 extra years when i hear y'all see a decent amount of peds anyway. (Ideal would be a lifestyle where i switch around as needed between peds / adult em, and possibly 1/2 days a week of outpatient peds, and i don't really care about academics, hoping to be in the northeast somewhere, but don't mind flying out to anywhere for my shifts and then coming back honestly)

 

[acetylcholinesterasee]

Alsooo not sure if y'all do this but if you see residents maybe tell them the types of salaries we should be looking for coming out of residency so we don't lower it? I feel like not enough doctors talk about that sort of stuff

 

[WilcoWorld]

Wilderness medicine fellowship basically equates to "How to start a campfire using actual dollar bills" since you are pretty much burning a hole in your pocket for absolutely zero gain forward.

Ok, that's pretty funny.

 

[namethatsmell]

I've been interested in PEM from the getgo, was considering applying to one of the EM/Peds combined, would that be a better idea? or definitely only PEM fellowship would help increase job market for me?

Yes, it would improve the amount of jobs available to you. You have to consider where these jobs would be. Many PEM jobs are at the big children's hospital in town. Have you worked at a place like that before? It's not everybody's cup of tea. There are community PEM jobs as well, some of which have the perks of no overnights (though more swing shifts).

I've been interested in it but not necessarily enough to warrant 2 extra years when i hear y'all see a decent amount of peds anyway. (Ideal would be a lifestyle where i switch around as needed between peds / adult em, and possibly 1/2 days a week of outpatient peds

I've met two people who did peds/EM training. Neither does outpatient peds. Consider what actually appeals to you about EM, PEM, peds. By now you've been reading about issues facing EM. PEM has it's own quirks depending on your personality--aside from lacs it's not very procedural and a bad outcome in PEM is...the worst. If you absolutely love working with kids and it's your dream then consider just doing a peds residency. It would give you the option to do peds crit care, neo, or cards etc which would all be much more insulated from the problems EM is grappling with right now. You could also still do PEM.

hoping to be in the northeast somewhere, but don't mind flying out to anywhere for my shifts and then coming back honestly

Most spouses will absolutely care. I did this for a bit while EM paid well. The opportunity cost of time away from home/family/friends and traveling was made up for by having to work fewer days/month since the hourly rate was higher. To try to do this in the future as a PEM seems like madness as I can't see it paying enough to justify it but that's just me. Ask yourself: does it make sense to spend hundreds of thousands of dollars and years of your life to build a career that routinely has you flying in and out for work?

 

[acetylcholinesterasee]

Yes, it would improve the amount of jobs available to you. You have to consider where these jobs would be. Many PEM jobs are at the big children's hospital in town. Have you worked at a place like that before? It's not everybody's cup of tea. There are community PEM jobs as well, some of which have the perks of no overnights (though more swing shifts).



I've met two people who did peds/EM training. Neither does outpatient peds. Consider what actually appeals to you about EM, PEM, peds. By now you've been reading about issues facing EM. PEM has it's own quirks depending on your personality--aside from lacs it's not very procedural and a bad outcome in PEM is...the worst. If you absolutely love working with kids and it's your dream then consider just doing a peds residency. It would give you the option to do peds crit care, neo, or cards etc which would all be much more insulated from the problems EM is grappling with right now. You could also still do PEM.



Most spouses will absolutely care. I did this for a bit while EM paid well. The opportunity cost of time away from home/family/friends and traveling was made up for by having to work fewer days/month since the hourly rate was higher. To try to do this in the future as a PEM seems like madness as I can't see it paying enough to justify it but that's just me. Ask yourself: does it make sense to spend hundreds of thousands of dollars and years of your life to build a career that routinely has you flying in and out for work?

Hey, thank you so much for your replies! A lot to think about I guess. I haven't been in a CHER yet but my PI works in one so hopefully I'll get in and see what you're talking about there.... community sounds great tho swing shifts are my jam. (Also heard you get to see more kids as an overnighter in regular EM?)

I love working with kids but I love working with "everything that walks through the door," from the minor to the major (though I guess that could be my naivety talking).

My dad did do that actually, but on second thought my parents divorced so maybe not xD Honestly though I value my freedom so if my future husband(if he exists) ever said he wasn't okay with that I'd boot him quick on principle

 

[Matthew9Thirtyfive]

Most spouses will absolutely care. I did this for a bit while EM paid well. The opportunity cost of time away from home/family/friends and traveling was made up for by having to work fewer days/month since the hourly rate was higher. To try to do this in the future as a PEM seems like madness as I can't see it paying enough to justify it but that's just me. Ask yourself: does it make sense to spend hundreds of thousands of dollars and years of your life to build a career that routinely has you flying in and out for work?

Definitely possible to find someone okay with it. My dad and his wife are lawyers, and one of them flies out every week for 3 days or so to see clients in a state about a thousand miles away. They have 2 kids and have been doing it for years out of choice, not necessity.

 

[namethatsmell]

Definitely possible to find someone okay with it. My dad and his wife are lawyers, and one of them flies out every week for 3 days or so to see clients in a state about a thousand miles away. They have 2 kids and have been doing it for years out of choice, not necessity.

It's great that it's worked well for you guys. I know another couple with a similar setup and it's worked well for them too. But most folks I've known who've tried something like this stopped after 6-24 months (myself included). I'm not sure why somebody would go through medical school and residency+/- fellowship with the idea that this would be their setup unless they were already married to somebody 100% on board with it.

 

[BeachBaby]

Southside Hospital (Bay Shore, NY) is an amazing new program. There's a medical student info session this Thursday at 7pm eastern on zoom. Link here:
More info on the program: Bay Shore Emergency Medicine Residency, Northwell Health, Southside Hospital

 

[GeneralVeers]

Seriously? That's amazing?

 

[DeadCactus]

I've been interested in PEM from the getgo, was considering applying to one of the EM/Peds combined, would that be a better idea? or definitely only PEM fellowship would help increase job market for me? I've been interested in it but not necessarily enough to warrant 2 extra years when i hear y'all see a decent amount of peds anyway. (Ideal would be a lifestyle where i switch around as needed between peds / adult em, and possibly 1/2 days a week of outpatient peds, and i don't really care about academics, hoping to be in the northeast somewhere, but don't mind flying out to anywhere for my shifts and then coming back honestly)

Peds EM seems to still be a decent market but typically pays lower than adult EM.

Peds-PEM (6 years) is the way to go if you don't want to see adults and want to work in an academic tertiary Children's Hospital and will be the gold standard from their perspective.

EM/Peds (5 years) or EM-PEM (5-7 years) is the advisable route to go if you the above doesn't apply to you. Far more job opportunities and more money. The community setting will generally look at the two as equivalent. Most academic centers will look at the two as equivalent. The combined route is broader clinical training and more flexibility to change to career paths down the road. The EM-PEM route may open a few doors at academic institutions (some don't hire EM/Peds), lets you be a PEM program director, and generally a little easier (since you're a fellow part of the time instead of a resident).

The majority of people interested in PEM who can enjoy seeing adults are best served by the EM-PEM route. People who only want to take care of kids are best of with the Peds-PEM route. People who value broad clinical training and career flexibility should explore the combined route.

 

[helodoc]

Global health to me seems like a PR campaign for an academic shop. "Look we travel to impoverished countries wearing our white coats from our Ivy league EM departments". I know people do good things in the global health world, but in terms of the marketability for it, it doesn't seem like there's that much need.

I think global health is a fairly worthwhile specialty. Maybe in some places it's a 'PR campaign' but at good academic institutions with really worthwhile missions these programs offer useful, meaningful aid. When I was in my med school I was pretty set on doing an ultrasound fellowship, and went on a trip where we brought an ultrasound machine to an ED in a low income country. We completely changed their practice patterns, they were now able to rule out intra-abdominal injury with a FAST, confirm pregnancy location, and evaluate cardiac function with an ECHO.

 

[Gastrapathy]

Posting an ad for a new program in a thread about the negative impact of all the new programs is next level