Emergency Medicine Residencies Actively Harming Our Specialty

[deleted547339]

Please use this thread to list EM residency programs that you believe are actively harming the field of Emergency Medicine and a brief description of why you believe this to be the case.

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[Dartmein]

In N Out.....heard they opened up a new PA fellowship O how the mighty have fallen.

 

[RustedFox]

*Insert all HCA residencies here*

 

[southerndoc]

Please do not list individual residencies in this thread. You can discuss residencies in general that aren't as good as others, but listing individual residencies as "harming emergency medicine" is bordering being libelous and will violate SDN Terms of Service agreements.

If you must list the individual residencies as harming emergency medicine, then I ask you to do so elsewhere.

 

[turkeyjerky]

Please do not list individual residencies in this thread. You can discuss residencies in general that aren't as good as others, but listing individual residencies as "harming emergency medicine" is bordering being libelous and will violate SDN Terms of Service agreements.

If you must list the individual residencies as harming emergency medicine, then I ask you to do so elsewhere.

Definition of libel:

"a published false statement that is damaging to a person's reputation; a written defamation."

I know society has taken the (disastrous) notion that a corporation is legally a person, but have we now defined residency programs as such as well? I am continually puzzled as to the insistence on secrecy regarding which programs:
--provide strong or weak training
--allow for adequete/excellent procedural experience
--provide good job prospects
--are actively seeking to destroy our profession

This information is both desired and deserved by the applicant pool, yet we keep it hidden from them-and-ourselves. We are all weaker for it.

If I were a prospective applicant, your alma mater would drop to the bottom of my ROL, even below the (unnamed) program whose PD made my skin crawl and stomach churn to degree I've not experienced before or since.

 

[WilcoWorld]

Definition of libel:

"a published false statement that is damaging to a person's reputation; a written defamation."

I know society has taken the (disastrous) notion that a corporation is legally a person, but have we now defined residency programs as such as well?

If the residency is run by a Corporate Management Group, does that make it a person?

 

[southerndoc]

I don't pretend to be an attorney, so it may or may not be libel. Hence the bordering comment.

My point was that I'm asking people to not name individual programs as it will only create arguments.

 

[Rekt]

I don't pretend to be an attorney, so it may or may not be libel. Hence the bordering comment.

My point was that I'm asking people to not name individual programs as it will only create arguments.

That's the point. We should absolutely call out a program. Don't specifically call out faculty/PD seems like a good medium.

Don't forget that graduates of your program will need to find jobs too. And I don't see any reason your program needs to be on the list so I'm not sure why you're so upset.

 

[southerndoc]

That's the point. We should absolutely call out a program. Don't specifically call out faculty/PD seems like a good medium.

Don't forget that graduates of your program will need to find jobs too. And I don't see any reason your program needs to be on the list so I'm not sure why you're so upset.

Because I don't want this turning into a big argument with different programs coming on trying to defend themselves, posters continued to say the program is awful, etc. I'm concerned because it's a violation of SDN's Terms of Service agreement -- it has nothing to do with my residency program.

You can call out any program you want as being bad, but not on SDN. If you want to post a review of a residency program with your honest opinions that you know first hand, then feel free to do that in a residency review thread.

I think we can all figure out which programs are fitting the category. Posting on SDN is not going to help our cause. Sending it to AAEM and having them put pressure on the RRC will help the most.

 

[Birdstrike]

I don't pretend to be an attorney, so it may or may not be libel. Hence the bordering comment.

My point was that I'm asking people to not name individual programs as it will only create arguments.

True information, by definition, cannot be libelous or slanderous. I'm board certified in EM and an EM subspecialty as are many on this board. Can you please clarify something for me. Maybe I'm misinterpreting your post. But are saying you're going to protect entities that are harming our specialty and its members by banning members from sharing information that would protect them from that harm, even if true?

If there is something harming our specialty or its member, shouldn't we be able to know?

If so, what better forum for that discussion, than a forum of Emergency Physicians?

 

[turkeyjerky]

Just gonna go ahead a leave this here w/o comment

Postgraduate Programs

 

[southerndoc]

True information, by definition, cannot be libelous or slanderous. I'm board certified in EM and an EM subspecialty as are many on this board. Can you please clarify something for me. Maybe I'm misinterpreting your post. But are saying you're going to protect entities that are harming our specialty and its members by banning members from sharing information that would protect them from that harm, even if true?

If there is something harming our specialty or its member, shouldn't we be able to know?

If so, what better forum for that discussion, than a forum of Emergency Physicians?

If you have first-hand knowledge of how a program operates, and if you think it's operating poorly, then you can post a review of that program.

To simply say "In & Out is a horrible program and hurts emergency medicine" isn't kosher. I never said you can't post an honest review about a program. A bad review is a bad review. However, the thread simply wants to call out programs that are harming our specialty. Harming is opinionated. Listing bad programs just because you think they're bad and do not serve a purpose isn't fostering a good discussion.

You should reread my posts. I'm just as concerned as you about the glut of residents being pumped out and less than ideal programs being accredited. However, I choose to voice my concerns by writing AAEM and trying to have them put pressure on the RRC instead of posting publicly in a forum that will do nothing but stir up arguments.

I've said all I will say about this. The ToS agreements do not allow this. I am trying to not lock the thread in the spirit of fostering good discussion, but good discussion doesn't mean finger pointing subjectively who you think is a bad program. It has nothing to do with protecting entities as much as it is protecting the integrity of our discussion forum.

 

[Birdstrike]

Please use this thread to list EM residency programs that you believe are actively harming the field of Emergency Medicine and a brief description of why you believe this to be the case.

Without listing any specific programs or names, what specifically are you referring to as harm? Are you referring to the fact that there are too many residencies flooding the supply of EPs? Or are you referring to programs that do a poor job of education?

Because if you're referring to the former, the problem is more with whichever entity has approved the addition of additional residencies. I don't think you can blame a specific residency, it residents or program director, for the system that allowed them to exist. If you're referring to bad education at a specific program, that's a different matter entirely, and certainly is the fault of the program itself.

 

[deleted547339]

Without listing any specific programs or names, what specifically are you referring to as harm? Are you referring to the fact that there are too many residencies flooding the supply of EPs? Or are you referring to programs that do a poor job of education?

Because if you're referring to the former, the problem is more with whichever entity has approved the addition of additional residencies. I don't think you can blame a specific residency, it residents or program director, for the system that allowed them to exist. If you're referring to bad education at a specific program, that's a different matter entirely, and certainly is the fault of the program itself.

At the risk of having the thread locked, I was looking to collate a list of programs that are doing things directly undermining the field for med students. If you look through the recent threads, you’ll figure out pretty quick what I am referring to.

 

[Birdstrike]

At the risk of having the thread locked, I was looking to collate a list of programs that are doing things directly undermining the field for med students. If you look through the recent threads, you’ll figure out pretty quick what I am referring to.

It might help to list what those things are, first, without naming names. Then you can review the programs in the other thread. Just a suggestion.

 

[Rekt]

It might help to list what those things are, first, without naming names. Then you can review the programs in the other thread. Just a suggestion.

-Any program with pretend-level provider fellowships or PLPs built into the curriculum.
-Any program that starts with "HCA-"
-Essentially any program that has opened in the past ~3 years when we already passed over the threshold of oversupply of EMPs.
-Especially any program opening right now or has ads for faculty.
-Any other program mainly attached to a CMG.

 

[GeneralVeers]

-Any program with pretend-level provider fellowships or PLPs built into the curriculum.
-Any program that starts with "HCA-"
-Essentially any program that has opened in the past ~3 years when we already passed over the threshold of oversupply of EMPs.
-Especially any program opening right now or has ads for faculty.
-Any other program mainly attached to a CMG.

- Any program that doesn't have a native Trauma designation of at least Level 2
- Any program that makes residents go out of state for specialized rotations
- Any programs where community pit doctors are forced to teach residents or be fired.

 

[WilcoWorld]

At the risk of having the thread locked, I was looking to collate a list of programs that are doing things directly undermining the field for med students. If you look through the recent threads, you’ll figure out pretty quick what I am referring to.

I don't think you'd be violating the ToS to simply state true facts.

So, if you post "The University of Ivy Towers is ruining medicine" not cool. But if you post "Since 2017 The University of Ivy Towers physician residents get 80% of their required intubations in the sim lab, 15% in the OR and less than 5% in ED patients. This is a dramatic change from before they started an APP residency and required senior physician residents to allow APP's 'first pass' for each ED intubation" I don't see how that could violate ToS (assuming it's true).

 

[southerndoc]

I don't think you'd be violating the ToS to simply state true facts.

So, if you post "The University of Ivy Towers is ruining medicine" not cool. But if you post "Since 2017 The University of Ivy Towers physician residents get 80% of their required intubations in the sim lab, 15% in the OR and less than 5% in ED patients. This is a dramatic change from before they started an APP residency and required senior physician residents to allow APP's 'first pass' for each ED intubation" I don't see how that could violate ToS (assuming it's true).

Correct. The first statement isn't cool. The second statement I don't see a problem with and certainly won't edit or delete a post that makes such a reference especially if you have first-hand knowledge of it. You can even post that you've heard a rumor that program X gets most of their intubations in the sim lab. Just stating it's ruining medicine without something backing it up is what I have a problem with.

 

[The Knife & Gun Club]

Carolinas has a huge PA residency which is integrated FWIW. And they’re still generally well regarded in the EM world.

Not saying it’s good or bad, just interesting. They were running a tight ship and seemed to have good resident training when I rotated there.

 

[southerndoc]

Carolinas has a huge PA residency which is integrated FWIW. And they’re still generally well regarded in the EM world.

Not saying it’s good or bad, just interesting. They were running a tight ship and seemed to have good resident training when I rotated there.

I'm sure there are a lot of programs that have PA residencies that are integrated at least partially. I thought MCG had one, but I didn't see it on the list that someone posted earlier.

 

[deleted547339]

Carolinas has a huge PA residency which is integrated FWIW. And they’re still generally well regarded in the EM world.

Not saying it’s good or bad, just interesting. They were running a tight ship and seemed to have good resident training when I rotated there.

I am fairly against any “board certification” or “residency” for those who aren’t doctors, but even still, I think it’s different to do it vs. go out of your way to publish trash research comparing the two when the sample size could never prove anything (not to mention a slew of other issues) and idiots can use it as “evidence.”

 

[deleted6669]

I'm sure there are a lot of programs that have PA residencies that are integrated at least partially. I thought MCG had one, but I didn't see it on the list that someone posted earlier.

They had one. The director was Dr. Bruce Janiak. You may recall that name from your training. He was the first EM Residency grad EVER.

 

[southerndoc]

They had one. The director was Dr. Bruce Janiak. You may recall that name from your training. He was the first EM Residency grad EVER.

I've never trained at MCG.

 

[deleted6669]

I've never trained at MCG.

I didn't mean to imply that you did, but figured you would know the name. He is the first EM residency grad ever and a well-known emergency physician, like Rosen, Goldfrank, Herbert, Mallon, etc.

 

[southerndoc]

I didn't mean to imply that you did, but figured you would know the name. He is the first EM residency grad ever and a well-known emergency physician, like Rosen, Goldfrank, Herbert, Mallon, etc.

Never heard of him.

 

[deleted6669]

Never heard of him.

A Brief History of Emergency Medicine Residency Training

3rd paragraph down.

 

[Apollyon]

Never heard of him.

Dude, with respect, I've heard of him, and I'm not even a member of ACEP (where they splatter his name everywhere)

 

[deleted6669]

Dude, with respect, I've heard of him, and I'm not even a member of ACEP (where they splatter his name everywhere)

Exactly. Mel Herbert called him out by name a few years ago in his keynote address for the 50th anniversary of ACEP. Great talk if you have never heard it. Mel Herbert is the best speaker in EM there is. Have heard him live many times. He can make anything interesting. Have been following him since he was doing audio digest on cassette tapes in the 90s.

 

[Apollyon]

Exactly. Mel Herbert called him out by name a few years ago in his keynote address for the 50th anniversary of ACEP. Great talk if you have never heard it. Mel Herbert is the best speaker in EM there is. Have heard him live many times. He can make anything interesting. Have been following him since he was doing audio digest on cassette tapes in the 90s.

I was there for that. Outstanding.

 

[southerndoc]

Dude, with respect, I've heard of him, and I'm not even a member of ACEP (where they splatter his name everywhere)

Never pretend to be a know it all. Haven't even read about him since someone mentioned his name.

On another note, I've been dealing with a ton of COVID patients all night long, long wait times in the ER, and an oversaturated emergency department that has an NEDOC score through the roof. 11 ICU admission holds, 40+ floor admission holds, running stroke alerts out of the hallway, EMS with long wall times, and nurses that are overworked/overstressed...

Gotta love the 'rona! Bring it on! I have some Bailey's and decaf calling my name when I get home in about 90 mins.

 

[namethatsmell]

Never pretend to be a know it all. Haven't even read about him since someone mentioned his name.

On another note, I've been dealing with a ton of COVID patients all night long, long wait times in the ER, and an oversaturated emergency department that has an NEDOC score through the roof. 11 ICU admission holds, 40+ floor admission holds, running stroke alerts out of the hallway, EMS with long wall times, and nurses that are overworked/overstressed...

Gotta love the 'rona! Bring it on! I have some Bailey's and decaf calling my name when I get home in about 90 mins.

I had to google what the heck a NEDOC score is. Very cool tool and a nice way to somewhat objectively validate just how challenging the environment was at the loudest, most wild shop I’ve ever worked at. For months at a time the place would run at a score of 5-6 and only sometimes dip to a 4 from early Saturday evening to the end of church the next day. It was literal chaos in a box. I miss it but I don’t miss it.

Enjoy that pre-bed drink!

 

[southerndoc]

Georgia requires that we post it online: www.georgiarcc.org

 

[deleted6669]

NEDOC score through the roof.

Interesting tool. Never seen it before. Just ran the #s for my last shift at the busiest place I work at and came up with 195

 

[turkeyjerky]

Never pretend to be a know it all. Haven't even read about him since someone mentioned his name.

On another note, I've been dealing with a ton of COVID patients all night long, long wait times in the ER, and an oversaturated emergency department that has an NEDOC score through the roof. 11 ICU admission holds, 40+ floor admission holds, running stroke alerts out of the hallway, EMS with long wall times, and nurses that are overworked/overstressed...

Gotta love the 'rona! Bring it on! I have some Bailey's and decaf calling my name when I get home in about 90 mins.

Wait, I thought that was best practice. Who needs a decent history and exam when TPA is safe for stroke mimics?

I feel you. It has been painful the past couple of weeks. I'm off all this month before I start my new job in Feb and I am not sorry.

 

[deleted941485]

WaPo Feels your pain....not

https://www.washingtonpost.com/health/2021/01/04/er-doctors-covid-jobs/

 

[alpinism]

Wait, I thought that was best practice. Who needs a decent history and exam when TPA is safe for stroke mimics?

I feel you. It has been painful the past couple of weeks. I'm off all this month before I start my new job in Feb and I am not sorry.

At my last hospital they were running stroke alerts out of triage.

 

[southerndoc]

At my last hospital they were running stroke alerts out of triage.

We did that in our old ER. The new ER has 3 rooms that the back wall has 2 large double doors that open directly into the CT suites. So we just move them there for assessment.

 

[Birdstrike]

Stupid question, from someone who knows exactly what HCA is all about: What do you all dislike so much about HCA residencies, other than the fact that they're flooding the market with EM grads? Is it mainly that? Is it an issue with the quality of training? All their residencies, or only EM? The fact that HCA is for-profit?

 

[RustedFox]

Stupid question, from someone who knows exactly what HCA is all about: What do you all dislike so much about HCA residencies, other than the fact that they're flooding the market with EM grads? Is it mainly that? Is it an issue with the quality of training? All their residencies, or only EM? The fact that HCA is for-profit?

All of the above.
Plus, forcing docs to teach who don't want to.

 

[Dr Mantis Toboggan]

Stupid question, from someone who knows exactly what HCA is all about: What do you all dislike so much about HCA residencies, other than the fact that they're flooding the market with EM grads? Is it mainly that? Is it an issue with the quality of training? All their residencies, or only EM? The fact that HCA is for-profit?

Yeah the hospitals they are putting many of these programs in are a joke. Nowhere near the needed acuity, trauma volume, procedure experience etc.

 

[watermanMD]

Exactly. Mel Herbert called him out by name a few years ago in his keynote address for the 50th anniversary of ACEP. Great talk if you have never heard it. Mel Herbert is the best speaker in EM there is. Have heard him live many times. He can make anything interesting. Have been following him since he was doing audio digest on cassette tapes in the 90s.

Really needed this. Thanks for posting.

 

[KGflyboy]

Stupid question, from someone who knows exactly what HCA is all about: What do you all dislike so much about HCA residencies, other than the fact that they're flooding the market with EM grads? Is it mainly that? Is it an issue with the quality of training? All their residencies, or only EM? The fact that HCA is for-profit?

All the above.

I highly doubt HCA admin has some sort of deep-rooted desire to educate future physicians for the good of society. This is not some generous way to "give back.". This is a way for them to get more cheap labor.

And for the record... I thought HCA sucked long before they decided to open up a ton of residencies.

 

[The Knife & Gun Club]

We did that in our old ER. The new ER has 3 rooms that the back wall has 2 large double doors that open directly into the CT suites. So we just move them there for assessment.

This is awesome. Did you all get to design your own ED And come up with this idea?

Reminds me of the resus bays in Japan where they have a CT scanner in the room at the head of the bed. Bad trauma? Primary survey then just zap them! No rolling!

First establishment of a new table-rotated-type hybrid emergency room system - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

The hybrid emergency room (hybrid ER) system was first established in 2011 in Japan. It is defined as an integrated system including an ER, emergency computed tomography (CT) and interventional radiology (IVR) rooms, and operating rooms. Severe trauma patients can undergo emergency CT...

sjtrem.biomedcentral.com

 

[southerndoc]

This is awesome. Did you all get to design your own ED And come up with this idea?

Reminds me of the resus bays in Japan where they have a CT scanner in the room at the head of the bed. Bad trauma? Primary survey then just zap them! No rolling!

First establishment of a new table-rotated-type hybrid emergency room system - Scandinavian Journal of Trauma, Resuscitation and Emergency Medicine

The hybrid emergency room (hybrid ER) system was first established in 2011 in Japan. It is defined as an integrated system including an ER, emergency computed tomography (CT) and interventional radiology (IVR) rooms, and operating rooms. Severe trauma patients can undergo emergency CT...

sjtrem.biomedcentral.com

We designed it. I wanted the CT scanner between the doors in the ambulance bay, but my opinion was usurped. Ambulance -> outer door -> CT -> inner door -> trauma bay.

It's a well designed, but very large ER. 12-bed critical care area on lower floor (3 rooms open directly to CT scanners). Lower floor also has 4 12-bed pods, a 16-bed adult pod (mainly for lower acuity patients), and a 16-bed pediatric pod. Upper floor has a 36-bed transition unit/obs unit and 2 12-bed pods plus a 10-bed psych unit. There is a 7-bed EMS offload area (for EMS patients to go before they're assigned a bed in the treatment area) as well as an EMS and front waiting room "de-escalation rooms" (basically a psych de-escalation room to sedate excited delirium/psychotic patients). No hall beds. Lower floor has 3 dedicated CT's, X-rays, ultrasound suite, and 24/7 MRI. Upper floor has a dedicated CT scanner and is staffed only during the day. It almost seems surreal how quiet the new ER is compared to the old ER.

 

[The Knife & Gun Club]

We designed it. I wanted the CT scanner between the doors in the ambulance bay, but my opinion was usurped. Ambulance -> outer door -> CT -> inner door -> trauma bay.

It's a well designed, but very large ER. 12-bed critical care area on lower floor (3 rooms open directly to CT scanners). Lower floor also has 4 12-bed pods, a 16-bed adult pod (mainly for lower acuity patients), and a 16-bed pediatric pod. Upper floor has a 36-bed transition unit/obs unit and 2 12-bed pods plus a 10-bed psych unit. There is a 7-bed EMS offload area (for EMS patients to go before they're assigned a bed in the treatment area) as well as an EMS and front waiting room "de-escalation rooms" (basically a psych de-escalation room to sedate excited delirium/psychotic patients). No hall beds. Lower floor has 3 dedicated CT's, X-rays, ultrasound suite, and 24/7 MRI. Upper floor has a dedicated CT scanner and is staffed only during the day. It almost seems surreal how quiet the new ER is compared to the old ER.

Jesus. That ED is bigger than some hospitals. I hope you’re enjoying it, it looks phenomenal.

 

[WilcoWorld]

Jesus. That ED is bigger than some hospitals. I hope you’re enjoying it, it looks phenomenal.

@southerndoc - I do NOT envy your scheduler! Or do you find that having such a big group gives more degrees of freedom and makes it easier to fill shifts? I'm associate director and my schedule requests can be difficult because of all the meetings I go to. Some of our docs are picky, some aren't.

 

[southerndoc]

@southerndoc - I do NOT envy your scheduler! Or do you find that having such a big group gives more degrees of freedom and makes it easier to fill shifts?

Our medical director uses ShiftAdmin. Honestly, I'm not sure how many hours she puts into it but I know it can be a hassle. She works hard to put it very lightly.

 

[crazyozone]

Any residency opened and/or run by a CMG. They are pumping residents into the job market so they can decrease pay via oversupply. ACEP, which is a joke, recently admitted that by 2030 there will be a surplus of 9000 EM physicians. This is in part due to the rapid opening of residencies, encouraged and taken in part by CMG's

 

[Rekt]

Any residency opened and/or run by a CMG. They are pumping residents into the job market so they can decrease pay via oversupply. ACEP, which is a joke, recently admitted that by 2030 there will be a surplus of 9000 EM physicians. This is in part due to the rapid opening of residencies, encouraged and taken in part by CMG's

This post is like walking into a restaurant 5 minutes before they close.



(Yes we 100% agree, just giving you crap).