Emergency Medicine Wins!!! More Residency Positions

[miacomet]

Thanks @Sushirolls, that was comprehensive and excellent. You kind of lump all subspecialty surgery together. I think neurosurgery and urology, with their limited numbers, long training, and exclusivity, will maintain their market as will a few other niches.

Radiology doesn't see it coming, but they will be crushed by AI and residency expansion more quickly than they realize.

But a great, great explanation of the coming doom, which will reflect what has happened in law and academia.

Tell your kids to go into the trades; it's the last refuge.

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[miacomet]

My specialty (rheum) used to be in demand. You can close your eyes, pick a city (except for NYC and LA) and have multiple offers on hand. In a few short years, it's been decimated. COVID may have accelerated the decline, but honestly it was gonna happen regardless.
The south is the only place that is still somewhat open. Anywhere else is saturated within 1 hour of a metro. I entirely expect even rural jobs to be gone within the next 3 years.

Unemployed docs is not only a possibility in the coming decade... it's an inevitability.

What's the reason? Midlevel encroachment? More fellowships opening?

 

[bronx43]

What's the reason? Midlevel encroachment? More fellowships opening?

Combination of forces. Midlevel encroachment, fellowship expansion, delaying of retirement of baby boomers, less consistent follow up due to financial constraints. After all, why should someone pay to see a specialist when they can see their PCP for free to get their Lyrica refilled? Even pts who are otherwise stable on biologics... they never actually come back more than twice a year.

Knowing what I know now, I would have gone into heme onc.

 

[Mad Jack]

So in 12 yrs, EM has increased 180%of positions and the field is essentially decimated.

Derm in 12 yrs has increased 110%, so as I think these trends will continue in the next 10 yrs they will be decimated.

You can lump psych all the way down to Orthopedics who all will be over 120% in 10 yrs.

I actually expect them all to be accelerated but the obvious point is all of these fields will have twice as much spots as their were 12 yrs ago. That is ALOT of docs being pumped out and the supply will greatly outweigh demand/retirements.

Psych is a bit of a different case, as psych positions had a significant contraction in the past where we closed a lot of programs. This resulted in a significantly larger older population of psychiatrists and a fairly small middle-aged one, so we'll probably see a decent job market for 20-30 years. Beyond that things could get ugly though

 

[Birdstrike]

You still don't believe in the Hospital-Government-CMG Complex?

 

[Birdstrike]

Save money, start early. Invest steadily. Invest smartly. Consistency, patience. Grow net worth. Hedge against coming dark clouds.

-Birdstrike

 

[miacomet]

Psych is a bit of a different case, as psych positions had a significant contraction in the past where we closed a lot of programs. This resulted in a significantly larger older population of psychiatrists and a fairly small middle-aged one, so we'll probably see a decent job market for 20-30 years. Beyond that things could get ugly though

It appears psych positions are increasing rapidly, and that psych NPs are a growing force.

 

[skougess]

You still don't believe in the Hospital-Government-CMG Complex?

Jesus it’s all of them. Who are these boomer judas-es?

 

[miacomet]

I certainly don't believe in private equity and what they are doing to medicine....

 

[wamcp]

My specialty (rheum) used to be in demand. You can close your eyes, pick a city (except for NYC and LA) and have multiple offers on hand. In a few short years, it's been decimated. COVID may have accelerated the decline, but honestly it was gonna happen regardless.
The south is the only place that is still somewhat open. Anywhere else is saturated within 1 hour of a metro. I entirely expect even rural jobs to be gone within the next 3 years.

Unemployed docs is not only a possibility in the coming decade... it's an inevitability.

Are there fewer residents going into rheum now? Or people just ignorant as ever?

 

[sloh]

PM&R will suffer next, but quietly, because there are so few of them and most people don't even know they exist. Token docs will be kept around for Rehab hospitals, but

It used to bother me people would confuse Physiatry with Psychiatry. No more. I hope my specialty stays under the radar and attracts no medical students! Trying to make bank with SNF work, hit FI, and liberate myself from this.

their only outpatient future rests on graces of ortho/neurosurgery groups keeping them around. There will be unemployed PM&R.

Just wait until the secret continues to spread that most of the popular outpatient procedures don't work (and this is what is being shown with sham-controlled RCT's). This includes interventional pain.

 

[Mad Jack]

It appears psych positions are increasing rapidly, and that psych NPs are a growing force.

Retirements outpace graduates though. And psych NPs aren't really a concern, there's a lot of things they legally just can't do in most states. Psych is unique when compared to other specialties in that there is an entire section of law and case law about what psychiatrists, specifically, can and cannot do in each state. Couple that with general competence and the ability of psych to more easily start our own practices and psych NPs just aren't much of a concern. In my area they're often going unemployed and ending up working as regular nurses due to the lack of jobs while psychiatrists still have plenty of offerings

 

[Sushirolls]

Retirements outpace graduates though. And psych NPs aren't really a concern, there's a lot of things they legally just can't do in most states. Psych is unique when compared to other specialties in that there is an entire section of law and case law about what psychiatrists, specifically, can and cannot do in each state. Couple that with general competence and the ability of psych to more easily start our own practices and psych NPs just aren't much of a concern. In my area they're often going unemployed and ending up working as regular nurses due to the lack of jobs while psychiatrists still have plenty of offerings

Not my area. They have full practice, and not too far from me is a group of 7+ ARNPs and they are running their own TMS machines. No state restrictions. Get pumped out by a local university and open up shop. What you describe may be a few state specific pockets of slower impact, but nationally, their infusion into the system will be felt. I'm already hearing from colleagues peppered across the country being replaced by ARNPs in Big Box shops.

Dark days for Psychiatry will hit. Its just a question of when. 10 years? 15? 20?

One of my local area Big Box Shop health systems, the worst of the worst, as evidenced by its repeat national news headlines for various reasons, took off the kid gloves for some of the psych ARNPs. What once was ridiculous cush for them, typical lower ARNP pay with a fractional panel of patients and numerous schedule gaps, is now expected to have an equally full schedule as the Psychiatrists and churn thru the patients just as much. This also happens to coincide with increasing insurance pay parity pushes for ARNPs in my state. That's a financial win for the Big Box shops. Same volume, same reimbursements, but fractional payroll to the providers. That's a win in every CEO eyes looking to secure their bonuses. If this health system is making such a change, then matter of time when the rest take off the kid gloves for their ARNPs.

 

[Mad Jack]

Not my area. They have full practice, and not too far from me is a group of 7+ ARNPs and they are running their own TMS machines. No state restrictions. Get pumped out by a local university and open up shop. What you describe may be a few state specific pockets of slower impact, but nationally, their infusion into the system will be felt. I'm already hearing from colleagues peppered across the country being replaced by ARNPs in Big Box shops.

Dark days for Psychiatry will hit. Its just a question of when. 10 years? 15? 20?

They can't involuntarily commit patients or perform many of the duties necessary from a legal perspective on inpatient psychiatric services. They don't meet the legal standard for weighing in on competency. There's other issues, but you'd have to be in the practice of local psychiatry to be familiar with them in any given area and the laws are too convoluted to bother explaining, with the gist being: only two people in this nation can take your freedom from you, a judge and a psychiatrist. States don't legally allow NPs or psychologists or anyone else to meet that standard

 

[Sushirolls]

They can't involuntarily commit patients or perform many of the duties necessary from a legal perspective on inpatient psychiatric services. They don't meet the legal standard for weighing in on competency. There's other issues, but you'd have to be in the practice of local psychiatry to be familiar with them in any given area and the laws are too convoluted to bother explaining, with the gist being: only two people in this nation can take your freedom from you, a judge and a psychiatrist. States don't legally allow NPs or psychologists or anyone else to meet that standard

Nope. Every state has different hold rules. Beyond the hold, and perhaps the actual day in court for commitment, perhaps there may need to be a Psychiatrist. A former Big Box shop I had worked at simply required the Psychiatrist to see the patients once before their commitment hearing who were technically the ARNP patients. We then got to testify. You only need to keep a fraction of Psychiatrists around - such as a single medical director - for an inpatient unit be the one to testify. That is still a small fractional need for Psychiatrists.

 

[sylvanthus]

Thanks @Sushirolls, that was comprehensive and excellent. You kind of lump all subspecialty surgery together. I think neurosurgery and urology, with their limited numbers, long training, and exclusivity, will maintain their market as will a few other niches.

Radiology doesn't see it coming, but they will be crushed by AI and residency expansion more quickly than they realize.

But a great, great explanation of the coming doom, which will reflect what has happened in law and academia.

Tell your kids to go into the trades; it's the last refuge.

No surgical subspecialty is safe. While NPs arent likely to direcrly do neurosurgery anytime soon, hospitals are already hiring a neurosurgeon with multiple midlevels for “rounding” to keep the surgeons in the OR. That will indirectly decrease the need for surgeons overall. If you normally would hire two surgeons but could hire one and keep him/her in the OR while midlevels see consults and round?.....

 

[Mad Jack]

Nope. Every state has different hold rules. Beyond the hold, and perhaps the actual day in court for commitment, perhaps there may need to be a Psychiatrist. A former Big Box shop I had worked at simply required the Psychiatrist to see the patients once before their commitment hearing who were technically the ARNP patients. We then got to testify. You only need to keep a fraction of Psychiatrists around - such as a single medical director - for an inpatient unit be the one to testify. That is still a small fractional need for Psychiatrists.

That really depends on the state. If you tried pulling that in one of the states I've worked in you would literally risk being held in contempt. But show me one state where you can be committed involuntarily by a nurse, I'll wait.

 

[sylvanthus]

They can't involuntarily commit patients or perform many of the duties necessary from a legal perspective on inpatient psychiatric services. They don't meet the legal standard for weighing in on competency. There's other issues, but you'd have to be in the practice of local psychiatry to be familiar with them in any given area and the laws are too convoluted to bother explaining, with the gist being: only two people in this nation can take your freedom from you, a judge and a psychiatrist. States don't legally allow NPs or psychologists or anyone else to meet that standard

Yet....

Whats to stop places from hiring a “supervising” errr sorry midlevels “collaborating” psychiatrist to oversee an army of NPs and if necessary do these things psychiatrists are only allowed to do while the army of of NPs do everything else?

 

[sylvanthus]

Lets be real here, NO area of
medicine is safe. We are continuing to F up because we think our speciality cant possibly be replaced by midlevels. While we simultaneously watch specialties fall like dominos. We are divided and being conquered.

 

[Mad Jack]

Yet....

Whats to stop places from hiring a “supervising” errr sorry midlevels “collaborating” psychiatrist to oversee an army of NPs and if necessary do these things psychiatrists are only allowed to do while the army of of NPs do everything else?

That's possible, though the legality could easily result in patients getting out of the unit with even a partially competent public defender. "How long have you spent directly caring for my client?" "I have not directly cared for your client." "And you expect to violate my client's civil rights after having never actually cared for them yourself? You are the one that should be locked up, not him." Case closed, patient walks. I don't know how many adversarial commitment hearings you've been a part of but even if you've got your **** together and know the patient very well their lawyers will pick apart your every word.

 

[Mad Jack]

Lets be real here, NO area of
medicine is safe. We are continuing to F up because we think our speciality cant possibly be replaced by midlevels. While we simultaneously watch specialties fall like dominos. We are divided and being conquered.

Oh my specialty isn't safe. But, based on projections, it should be safe *until I retire* and that's all I can hope for

 

[wendalltwolf]

And for the more procedure-based specialties (cross post from Pain):

When the hospital gets paid ten times what the doc does for the procedure we have a real problem. Pretty sure we are on the last years of non-socialized medicine.

 

[emergentmd]

Haven't had a family member in ICU until this past weekend. Just seeing the CC NP admit, put in orders, without seeing the pt showed me CC is screwed. If a doc is not needed to admit a somewhat complicated CC pt, then they just screwed their field.

I thought CC medicine would be one of the last refuge due to the complexity. I can see in 5 yrs all specialist having APCs admit everything, essentially running the show, with a doc just signing off on orders.

I thank my lucky starts that I am about at retirement and still have a job where I practice medicine being my own boss. Sucks to be a new attending now, worse being a resident, and even worse a med student that will be an attending in 5-10 yrs.

 

[sylvanthus]

Yup CC is fuxxored like the rest. Im just riding the wave as long as I can before it recedes and I drown or swim my ass to shore.

 

[sylvanthus]

Sweet flood the market more, why not?

 

[tomballunger]

Speaking of surgical subs, they are extremely difficult to match nowadays, even if a med student did everything right, trying to get high scores, grades, research (look at how many went unmatched into ent uro etc). And when one doesn't match into surgical subs, it's hard to reapply and opportunities to try to get into a viable backup are also few. So trying to go into surgical subs as a med student isn't really safe either until they match or in this era of zoom interviews can easily apply to backups

 

[Rekt]

"HCA likes this post"

 

[sylvanthus]

Had a patient transferred down from an outside hospital for probable nstemi, in a couple pressorz, uroseptic, mainly for cards eval since they dont have cards up there.

Guess who sees them.....














An NP.

Ya baby ‘murica.

 

[Fart Daddy Smooth]

The silver lining in all of this is somewhere along the way there will bound to be some ticked off docs who filter into law, or filter into politics. The blend of law suits and increased legislative presence could be a source for change.

Cmon, you really expect US legislators to favor physicians over the corporations that bankroll their entire existence?

Labor unions are what you all need, but those won't ever happen. Too many folks only concerned about their own interests.

Great write up, btw

 

[GeneralVeers]

Cmon, you really expect US legislators to favor physicians over the corporations that bankroll their entire existence?

Labor unions are what you all need, but those won't ever happen. Too many folks only concerned about their own interests.

Great write up, btw

It's all part of the larger corporatization and monopolization of every American Industry. Entertainment, Cable, Speech Platforms have all become monopolies.

 

[emergentmd]

Social media has raised the vail on medicine. The majority of Facebook, twitter, media stories are on large doc bills, mistakes, greedy docs, insurance scams, how great APCs are, long waits.

The respect for the field continues to drop and many pts don't care who they see. They just want to get seen, get their script, and don't care who does it. Its the McDonald's of medicine. Food sucks, we know its bad for you, but people love it b/c its cheap and convenient.

 

[Birdstrike]

Social media has raised the vail on medicine. The majority of Facebook, twitter, media stories are on large doc bills, mistakes, greedy docs, insurance scams, how great APCs are, long waits.

The respect for the field continues to drop and many pts don't care who they see. They just want to get seen, get their script, and don't care who does it. Its the McDonald's of medicine. Food sucks, we know its bad for you, but people love it b/c its cheap and convenient.

We are hot dog vendors

Ruminations On Hot Dogs & Emergency Medicine​

I was told once, at the start of my career in EM, the difference in being a "customer" versus a "vendor" and that this would dictate how I was treated throughout my career. I had no idea how important this was, and how much it would permeate every nook and cranny of my job, and the system I had to navigate.

You see, a spine surgeon for example, is a "customer" of the hospital. He brings a practice, patients and therefore money to a hospital. If he leaves, the practice, the patients and the money go with him. The spine surgeon is the guy that walks up to the hot dog stand and every night orders 100 hot dogs. We don't always have to like him, but "By golly!" he pays half of our quarterly bonus! This customer must be kept happy, at all costs. He's a high roller, making him rich can makes us rich, and there's not that many of him out there. "The customer is always right," and the customer will be treated accordingly. Customer a-s is always kissed.

A patient, also is a customer. A patient brings with him a goody bag of the hospitals favorite treats called an insurance card. It is this goody bag that he gives as currency in exchange for a hot dog. If the patient leaves the hospital, he takes the goody bag with him. This goody bag could contain a lump of coal, or more often a few hundred dollars. Hell, sometimes we've gotten goody bags with tens of thousands of dollars in them (chest-pain admit, heart-cath, plus big facility fees), or hundreds of thousand dollars (complex spine surgery, trouble with vent weaning, prolonged ICU course) hiding in them! This customer doesn't always tip big, and doesn't always buy lots of hot dogs, but damn it, there's TONS just like him out there. We can afford to p-ss off a couple here or there, but on balance, if we keep most happy, and keep them coming, the numbers will add up. Once again, "this customer is always right," and the customer will be treated accordingly. Customer a-s is always kissed, ESPECIALLY when they carry goody bags full of surprises.

An Emergency Physician is, well...a vendor. He's the guy selling the hot dogs at the stadium (myself included). His job is primarily to keep the goody-bag bearing customers happy, and to keep the lines a movin'. His job is an important one, no doubt, but it's different. He comes to the hospital with no goody bag of his own and no practice, patients or business to bring. Sure, we'd like to rent a space to somebody with a hot dog cart, 'cause after all, a big juicy hot dog does keep the customers happy after all. But we don't really care if it's Nathan's Hot Dogs, Hebrew National, or Tap Dance Coney, as long as the customers like it. And you know what, after all, if Tap Dance Coney gets tired of tap dancing, or gets tired of following all of our stupids sanitation policies, it's cool. We'll just call Nathan's, Hebrew National, Outhouse Dog, or who gives a rip, we'll bring in someone not even fully trained to cook hot dog. After all, the others have been drooling over the contract and have all been promising to do it for cheaper. After all, the customers just want a halfway decent friggin' hot dog, service with a smile and to get back to watching the damn game.

A smart vendor knows his place, knows who's who, and what everyone's role is. A smart vendor knows that it's a privilege to be given the opportunity to have access. After all, it is access to the "customers," that pays the vendor's bills. A smart vendor never loses sight of the fact that even though the customers sometimes can be very difficult and demanding, they put food on his table. A smart vendor that shows up early, leaves late and wears a polite smile in the face of adversity will be able to pay his bills, and may even do very well if he can grill a halfway decent dog. A vendor, however, will never be treated like a "customer," and definitely never like the high roller. If a vendor gets to big for his own britches, well...we'll just get a new one who'll fit in the pants.

 

[miacomet]

Two to five more years! Then I'm done!

 

[Ole_Toe]

Two to five more years! Then I'm done!

As a current med student, this is obviously very concerning, but I appreciate you all sounding the alarm so we at least know what we’re getting into. Academic attendings and career counselors are not talking about this at all. Thanks for that breakdown @Sushirolls. I agree that neuro will be safe but have even higher burnout in employed positions with unnecessary consults. Curious how fields like FM, ophthalmology, and psych will fare with private practice options. Hard to know how to factor all this in when deciding on a specialty. Getting out really isn’t an option for most.

 

[emergentmd]

As a current med student, this is obviously very concerning, but I appreciate you all sounding the alarm so we at least know what we’re getting into. Academic attendings and career counselors are not talking about this at all. Thanks for that breakdown @Sushirolls. I agree that neuro will be safe but have even higher burnout in employed positions with unnecessary consults. Curious how fields like FM, ophthalmology, and psych will fare with private practice options. Hard to know how to factor all this in when deciding on a specialty. Getting out really isn’t an option for most.

I don't see how Neurology is protected, I see it as another domino to fall. What makes them so protected? If neurologists becomes a shortage, the same supply/demand will take hold with more students going into it, become the new derm, and VC will start to flood the market to lower income.

 

[2021Doctor]

I wonder how the EM match in 2022 will compare to nephrology

AY 2020 Nephrology Match

 

[fiji128]

March 24, 2021

The Honorable Bob Menendez The Honorable John Boozman
U.S. Senate U.S. Senate
528 Hart Senate Office Building 141 Hart Senate Office Building
Washington, DC 20510 Washington, DC 20510
The Honorable Chuck Schumer
U.S. Senate
322 Hart Senate Office Building
Washington, DC 20510

Dear Senator Menendez, Senator Boozman, and Majority Leader Schumer:

On behalf of the Graduate Medical Education (GME) Advocacy Coalition, the undersigned
organizations offer our enthusiastic support for the Resident Physician Shortage Reduction Act
(S. 834). This bipartisan legislation is crucial to expanding the physician workforce and to
ensuring that patients across the country are able to access quality care from providers.
The need for physicians continues to grow faster than supply, leading to an estimated shortfall of
between 54,100 and 139,000 primary care and specialty physicians by 2033. The COVID-19
pandemic has further exposed the significant barriers to care that patients face, and has also
highlighted rising concerns of clinician burnout. This is particularly alarming given that more
than two of five currently active physicians will be 65 or older within the next decade, raising
concerns about the impact of physician retirement. Additionally, the U.S. population is
continuing to both grow and age, and access issues persist in rural and underserved areas. The
physician workforce is a critical element of our nation’s health care infrastructure, and if we do
not address this impending problem, patients from pediatrics to geriatrics and nearly everyone in
between, will find it even more difficult to access the care they need.
America’s medical schools, teaching hospitals, and their physician partners are doing their part
by investing in physician and health care provider training and leading innovations in new care
delivery models that are more efficient and include better use of technologies — like telehealth
— that improve patient access to care. Even with these efforts, however, shortages and access
challenges will persist unless we expand the physician workforce.
We are grateful that bipartisan congressional leaders worked together to provide 1,000 new
Medicare-supported GME positions in the Consolidated Appropriations Act, 2021 – the first
increase of its kind in nearly 25 years. The Resident Physician Shortage Reduction Act of 2021
would build on this historic investment by gradually raising the number of Medicare-supported
GME positions by 2,000 per year for seven years, for a total of 14,000 new slots. A share of
these positions would be targeted to hospitals with diverse needs including hospitals in rural
areas, hospitals serving patients from health professional shortage areas (HPSAs), hospitals in
states with new medical schools or branch campuses, and hospitals already training over their
caps.
We look forward to working together to support the training of future physicians and to secure
the passage of this important legislation.

Sincerely,

Association of American Medical Colleges
Academic Consortium for Integrative Medicine & Health
Academy for Professionalism in Health Care
Alliance for Academic Internal Medicine (AAIM)
Alliance of Specialty Medicine
America's Essential Hospitals
American Academy of Addiction Psychiatry
American Academy of Allergy, Asthma & Immunology
American Academy of Hospice and Palliative Medicine
American Academy of Neurology
American Academy of Ophthalmology
American Academy of Physical Medicine & Rehabilitation
American Association of Chairs of Departments of Psychiatry
American Association of Colleges of Osteopathic Medicine
American Association of Directors of Psychiatric Residency Training
American Association of Neurological Surgeons
American Association of Orthopaedic Surgeons
American College of Academic Addiction Medicine (ACAAM)
American College of Mohs Surgery
American College of Obstetricians and Gynecologists
American College of Physicians
American College of Radiology
American College of Rheumatology
American College of Surgeons
American Gastroenterological Association
American Geriatrics Society
American Headache Society
American Medical Association
American Medical Student Association
American Osteopathic Association
American Psychiatric Association
American Society for Clinical Pathology
American Society for Reproductive Medicine (ASRM)
American Society of Addiction Medicine
American Society of Anesthesiologists
American Society of Echocardiography
American Society of Hematology
American Society of Plastic Surgeons
American Urological Association
Association of Academic Health Sciences Libraries
Association of Academic Physiatrists
Association of Minority Health Professions
Association of Pathology Chairs
Association of Professors of Dermatology
Association of Professors of Gynecology and Obstetrics
Association of University Professors of Ophthalmology (AUPO)
Catholic Health Association of the United States
Children's Hospital Association
Coalition of State Rheumatology Organizations
College of American Pathologists
Congress of Neurological Surgeons
Federation of American Hospitals
Greater New York Hospital Association
Healthcare Association of New York State
Heart Failure Society of America
Illinois Health and Hospital Association
Medical Group Management Association
National Association of Spine Specialists
Premier Healthcare Alliance
Society for Academic Emergency Medicine
Society for Vascular Surgery
Society of Academic Associations of Anesthesiology and Perioperative Medicine
Society of Directors of Research in Medical Education
Society of General Internal Medicine
Society of Hospital Medicine
Society of University Surgeons
Student National Medical Association (SNMA)
The Society of Thoracic Surgeons
Vizient, Inc.

https://www.facs.org/-/media/files/advocacy/federal/senate_gmac_resident_physician_shortage_reduction_act_of_2021.ashx

Yikes!

 

[Taurus]

Neurology is the real winner. Because even PAs and ARNPs know that neurology is tough and few dare to enter in the first place and those who do get chewed up and spit out quickly.

Lol. When has “not knowing what they are doing” or “in over their heads” ever stopped NP’s from doing something? If they had the decency to respect such concepts, they wouldn’t be pushing for autonomy for all patients in all settings. They will just show compassion and empathy and fake their neurology skills. Unlike radiology where images do not change and can be preserved indefinitely, an NP can do a poor job on the physical exam and miss many things but it’s very difficult to prove it. Foot drop? Droopy eye? Weak arm? “It wasn’t there when I examined the patient!” exclaims the NP with her own independent neurology practice.

 

[skougess]

Lol. When has “not knowing what they are doing” or “in over their heads” ever stopped NP’s from doing something? If they had the decency to respect such concepts, they wouldn’t be pushing for autonomy for all patients in all settings. They will just show compassion and empathy and fake their neurology skills. Unlike radiology where images do not change and can be preserved indefinitely, an NP can do poor job on the physical exam and miss many things but it’s very difficult to prove it. Foot drop? Droopy eye? Weak arm? “It wasn’t there when I examined the patient” exclaims the NP with her own independent neurology practice.

This reasoning always get me.
“NPs will never take over OUR specialty because they can’t do....”
Dude/Dudette. They can’t do EM either, but no one in charge cares.

 

[gamerEMdoc]

While we are leading the charge on over-expansion, its clear that this is a problem accross many fields of medicine. The constant expansion of medical schools feeds into this demand for more and more spots. The more schools that open, the more spots that are needed, the demand is there, and CMG run residencies can take advantage of that demand. Stopping EM expansion is a bandaid on the overall problem in medicine, one that is sorely needed obviously, but we need to stop medical school expansion and all the rest should fall into place.

 

[miacomet]

Yeah, but EM is getting slaughtered right now. Psych, for example, probably has a few more years. So I think we need to own that and be honest about it.

 

[Birdstrike]

This reasoning always get me.
“NPs will never take over OUR specialty because they can’t do....”

It's all fine and good to believe patients "will accept nothing but the highest levels of training" and that "it'll all work itself out." But that misses one very important fact. Many patients don't care whether "doctors or mid-levels do it better."

Because they the patient can do it better! They know what they need. They know how to google. They know how to self diagnose and self treat. We, are merely and inconvenient and unnecessarily expensive conduit. Sprinkle on top of that the administrators' sacred belief that "the customer is always right" and you've got Medicine in 2021, in a nutshell. The patient's and administrators are in cahoots. They work as a team. We are merely the ball.

 

[bravotwozero]

While we are leading the charge on over-expansion, its clear that this is a problem accross many fields of medicine. The constant expansion of medical schools feeds into this demand for more and more spots. The more schools that open, the more spots that are needed, the demand is there, and CMG run residencies can take advantage of that demand. Stopping EM expansion is a bandaid on the overall problem in medicine, one that is sorely needed obviously, but we need to stop medical school expansion and all the rest should fall into place.

Gamer, are you willing to publicly go on record and say that? I think most PDs wouldn’t because they believe their livelihoods depend on doing the opposite...

 

[Sushirolls]

While we are leading the charge on over-expansion, its clear that this is a problem accross many fields of medicine. The constant expansion of medical schools feeds into this demand for more and more spots. The more schools that open, the more spots that are needed, the demand is there, and CMG run residencies can take advantage of that demand. Stopping EM expansion is a bandaid on the overall problem in medicine, one that is sorely needed obviously, but we need to stop medical school expansion and all the rest should fall into place.

This is wrong. Stopping the number of medical school graduates isn't need. We have and still are bringing in IMGs. The shear expansion expansion of midlevels shows there is room for more Physicians as a whole. Stopping medical school expansions simply leaves more vacuum for more ARNPs/PAs.

• What needs to be done is flooding the market now, with MD/DO graduates.
• Eliminate step/level 3 for licensure, and grant independent state licenses after MD/DO graduation. A sea of GPs that now replace and fill the roles of ARNPs PAs.
• Specialties can now focus on limiting their specialty numbers to real clinical needs - if not, like EM - you have some that can't practice in EM and revert back to being GPs

 

[curiousneuro]

It's all fine and good to believe patients "will accept nothing but the highest levels of training" and that "it'll all work itself out." But that misses one very important fact. Many patients don't care whether "doctors or mid-levels do it better."

Because they the patient can do it better! They know what they need. They know how to google. They know how to self diagnose and self treat. We, are merely and inconvenient and unnecessarily expensive conduit. Sprinkle on top of that the administrators' sacred belief that "the customer is always right" and you've got Medicine in 2021, in a nutshell. The patient's and administrators are in cahoots. They work as a team. We are merely the ball.

This right here. Truth.

 

[curiousneuro]

I don't see how Neurology is protected, I see it as another domino to fall. What makes them so protected? If neurologists becomes a shortage, the same supply/demand will take hold with more students going into it, become the new derm, and VC will start to flood the market to lower income.

There's a large shortage of neurologists that's been going on for a long time - that's not new. Some of the differences with us and other specialties is:

1. Reliance on history/exam over testing/imaging makes it difficult to "fake" your way through, which turns off midlevels
2. Not a lot of med students are interested in neurology because, let's face it - the subject matter is not for everyone!
3. We can't pound through 50 patients/day like derm can because so much of what we do relies on a thorough history/exam, so neuro is just not as lucrative to VCs

 

[skougess]

There's a large shortage of neurologists that's been going on for a long time - that's not new. Some of the differences with us and other specialties is:

1. Reliance on history/exam over testing/imaging makes it difficult to "fake" your way through, which turns off midlevels
2. Not a lot of med students are interested in neurology because, let's face it - the subject matter is not for everyone!
3. We can't pound through 50 patients/day like derm can because so much of what we do relies on a thorough history/exam, so neuro is just not as lucrative to VCs

You can pound through 50 patients a day/skip the thorough physical exam if you don’t give a **** about outcomes. Your drive to deliver good patient care blinds you to the realities of administrator priorities.

 

[2021Doctor]

New Programs

 

[clibby]

New Programs

View attachment 336524

If it is any consolation, some of those (Baystate, LLU, MCW, Morristown, and UAB) are established programs starting fellowships. Still, the number of new programs is not slowing down.

 

[emergentmd]

Once Neurology becomes sought after, they will follow the same path.

Anyone who thinks neurology is too complicated for an NP, you got to be kidding yourself. If an NP can admit CC patients, then outside of making a TPA decision, they can be admitted by an NP.

Lets not kid ourselves. In 5 yrs, many specialities will be feeling EMs pain and hopefully enough will not go into EM for it to thrive again. Its all cycles and now that docs have little control over their destiny, we are just like any other commodity.

Demand goes up, supplies goes up. Supply outpace demand, supply goes down.