Emergency Medicine Wins!!! More Residency Positions

[Birdstrike]

Is AI even a bad thing? I'm serious because AI looks like a tool for physicians to make better decisions

My guess is that AI will amount to nothing but an algorithm-run decision rule that will ultimately come with the usual disclaimer,

“Although this AI algorithm can aid in decision making, it cannot replace clinical judgement, therefore all decisions must ultimately be made by the treating physician provider.”

If we ever get to the point AI can be sued instead of the treating doc, then it might actually be worth something. But until then...

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[bravotwozero]

The ambulance chasers won’t directly sue AI of course, but the people who manufacture the technology can most certainly be sued, like anyone else in this country...

 

[DeadCactus]

What’s even worse is that PA residents are treated as fellows while interns are generally disrespected

I would attribute this to one of the largest flaws in US GME: the PA can say "f*** this", leave two months in, and go make 6 figures. The MD/DO can say "f*** this", leave two months in, and go live in poverty with a useless degree and no real job prospects. Imagine how different residency would be if the residents could bail out and transfer credit to another specialty/program easily or work as a non-residency trained GP under someone board certified; if programs had to worry as much about residents quitting as residents have to worry about being fired. The whole training paradigm should be more modular and flexible.

Hell, not only would it fix a lot of the issues residents face but it would fix a lot of the problems at the attending level. Imagine the EM job market if the barrier to retraining in a different specialty was lowered? How many EM physicians would be retraining to another specialty right now if residencies had to compete on an open market with hours, pay, and culture?

 

[Birdstrike]

How many EM physicians would be retraining to another specialty right now if residencies had to compete on an open market with hours, pay, and culture?

Thousands. They are currently held captive. It is my goal to help them break the chains that hold them.

 

[alpinism]

Hell we'd lose hundreds of EM residents if they could switch to another specialty.

 

[GeneralVeers]

I've always thought it strange that you are bound and stuck to a specialty for eternity based on a choice you make as an immature 25-26 year old.

 

[TheComebacKid]

Hell we'd lose hundreds of EM residents if they could switch to another specialty.

yeah but they would be no better off. there would be an equal number of people from other specialties switching into EM.

If y'all think that we are trapped in EM, think about the sad neurosurgeons. Horrible lifestyle. Insanely high liability. Ridiculous training pathway of upwards of 8 years plus sometimes fellowship after? Miserable existence. I can guarantee you many of them would gladly sign off on some midlevel charts and put up with some BS hospital metrics to work 14 shifts per month in the ED.

Grass is always greener.

EM is going through a really, really awful time right now. Arguably worse than other specialties. But it's not like it's peachy out there for everyone.

 

[GassYous]

yeah but they would be no better off. there would be an equal number of people from other specialties switching into EM.

If y'all think that we are trapped in EM, think about the sad neurosurgeons. Horrible lifestyle. Insanely high liability. Ridiculous training pathway of upwards of 8 years plus sometimes fellowship after? Miserable existence. I can guarantee you many of them would gladly sign off on some midlevel charts and put up with some BS hospital metrics to work 14 shifts per month in the ED.

Grass is always greener.

EM is going through a really, really awful time right now. Arguably worse than other specialties. But it's not like it's peachy out there for everyone.

I know a guy who went right into em residency after finishing im. He graduates this year. I thought it was an awful decision before covid hit...

 

[DeadCactus]

yeah but they would be no better off. there would be an equal number of people from other specialties switching into EM.

If y'all think that we are trapped in EM, think about the sad neurosurgeons. Horrible lifestyle. Insanely high liability. Ridiculous training pathway of upwards of 8 years plus sometimes fellowship after? Miserable existence. I can guarantee you many of them would gladly sign off on some midlevel charts and put up with some BS hospital metrics to work 14 shifts per month in the ED.

Grass is always greener.

EM is going through a really, really awful time right now. Arguably worse than other specialties. But it's not like it's peachy out there for everyone.

That's fine, let people switch into EM too. The point is to create fluidity in the job market so that the market for each specialty has to remain enticing to people working rather than to pre-meds and medical students. Right now, the barriers to exit are so high that physician desires have an excessively weak standing in the job market. I agree that other specialties are no panacea, the entire field is struggling for a variety of reasons, but I think medicine as a whole would be improved by allowing this balancing to happen. Even better would be to additionally decrease the barrier to exit from medicine as a whole by decreasing medical student debt, paying a stipend to medical students, and increasing resident salaries.

 

[Dr Mantis Toboggan]

I know a guy who went right into em residency after finishing im. He graduates this year. I thought it was an awful decision before covid hit...

I knew a guy who matched EM in NYC, transferred to IM in Michigan 1-2 years in, finished IM there and then went back and did EM at another program.

 

[TaroBubbleTea]

I knew a guy who matched EM in NYC, transferred to IM in Michigan 1-2 years in, finished IM there and then went back and did EM at another program.

Maybe he just really loves residency

 

[emergentmd]

Grass is never always greener. If you are FM that works corporate making 250K a yr, have no control, sees pts every 15 min, charting at home, told what to do at every step you would bet many FMs would be doing EM.

I can really only think of less than 5 fields I would go into if I was given the chance right now.

 

[blue.jay]

Grass is never always greener. If you are FM that works corporate making 250K a yr, have no control, sees pts every 15 min, charting at home, told what to do at every step you would bet many FMs would be doing EM.

I can really only think of less than 5 fields I would go into if I was given the chance right now.

What are those 5 fields ?

 

[emergentmd]

I would do Ortho, GI, Plastics, IR which is about it. Nothing strictly office based and most hospital based ruled out as they are no better than EM.

 

[sloh]

Grass is never always greener. If you are FM that works corporate making 250K a yr, have no control, sees pts every 15 min, charting at home, told what to do at every step you would bet many FMs would be doing EM.

I can really only think of less than 5 fields I would go into if I was given the chance right now.

Lol, this sounds exactly like Kaiser FM. Burnout rates are staggering there.

 

[Kryptocoin]

I've always thought it strange that you are bound and stuck to a specialty for eternity based on a choice you make as an immature 25-26 year old.

Sounds like marriage doesn't it? I've always wondered how people choose life partners in their 20s. I guess there's a reason why divorce rate is 50%. The other 45% probably settle or figure it's cheaper to keep him/her.

 

[GeneralVeers]

Sounds like marriage doesn't it? I've always wondered how people choose life partners in their 20s. I guess there's a reason why divorce rate is 50%. The other 45% probably settle or figure it's cheaper to keep him/her.

It's to further procreation. Women are most fertile in their 20's so makes sense logically. Also people used to die in their 30's from all sorts of causes, and we have continued the tradition of marrying young as a holdover from ancient times.

The same with residency training. It's a holdover from many years ago that hasn't changed with differing realities of medicine, and with increased lifespan.

 

[emergentmd]

Sounds like marriage doesn't it? I've always wondered how people choose life partners in their 20s. I guess there's a reason why divorce rate is 50%. The other 45% probably settle or figure it's cheaper to keep him/her.

Just from personal experience I find that
1. 50% hate their partner and get a divorce. Many of these are serial divorcers and really would always complain about their marriage
2. 25% stick it out because of kids or finances but generally unhappy
3. 12.5% find marriage to be no worse/better than single, hate the risk of change, and are essentially satisfied with their marriage
4. 6.25% are typically happy with their daily marriage but issues pop up where they question their marriage but after evaluation find that they are lucky to be married to the person.
5. 6.25% are in love with their partner and could not live without them even after 20 yrs regardless of any obstacles that arises. Together, they make each other better and overcome obstacles without much isses.

Sounds alot like many doctors.

 

[Old_Mil]

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.

The fact that you're reading this as a medical student already puts you well ahead of your peers. Part of the medical education process is to keep the MS ignorant about the realities of medical practice until it's too late to make a course correction.

 

[Birdstrike]

Part of the medical education process is to keep the MS ignorant about the realities of medical practice until it's too late to make a course correction.

Most pre-meds won’t believe that a planned ignorance is an essential core process in the grooming of medical trainees, without which modern Medicine cannot survive. But it’s 100% true.

Every pre-med needs to print this post by @Old_Mil and permanently glue it to their bathroom mirror. Because it is dead true and not a bit exaggerated.

 

[LondonVibes]

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[LondonVibes]

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[GeneralVeers]

I feel like the best solution would be increasing residency slots to the point there’s barely a physician shortage. That way we put the NPs in an appropriate place but also solve the physician shortage.

Have you been paying attention to anything on this forum? Please go back and re-read the other threads, then edit your post accordingly.

 

[LondonVibes]

Have you been paying attention to anything on this forum? Please go back and re-read the other threads, then edit your post accordingly.

I see the error of my ways. This is something I should do more research on for sure.

 

[gluon999]

Rads here. I truly feel bad for EM docs. As far as the radiology comments, the images live forever and any NP/PA silly enough to offer their interpretation as a final read would be dumb. AI is in its infancy, we use it everyday, but its like a first year resident on call. Obviously it will improve but what AI company will want the final liability for reads? None!

 

[Groove]

I knew a guy who matched EM in NYC, transferred to IM in Michigan 1-2 years in, finished IM there and then went back and did EM at another program.

I've known a few of these but it's usually IM followed by EM. I think a lot of these people are hopelessly trapped in grandiose idealistic fantasies about some sort of nirvana state of personal fulfillment that they think can only be achieved through one particular specialty and they also erroneously imagine that it can be maintained throughout their entire life. Most are hopelessly depressed and disillusioned about 3 years into private practice.

The other subset are people afraid to leave the nest. I know one guy who did a neurology residency followed by a gazillion fellowships. We finished our residencies around the same time and by the time I saw a Facebook post about him starting private practice, I had literally been out practicing almost 6 years. Whoever is going to sacrifice 6 years of 300+/yr for a fellowship that wouldn't pay them any more than they would have made fresh out of residency needs to get their head checked out.

No specialty is still exciting after 10 years. Most are probably barely tolerable after 20.

 

[2021Doctor]

I've known a few of these but it's usually IM followed by EM. I think a lot of these people are hopelessly trapped in grandiose idealistic fantasies about some sort of nirvana sate of personal fulfillment that they think can only be achieved through one particular specialty and also imagine that it can be maintained throughout their entire life. Most are hopelessly depressed and disillusioned about 3 years into private practice.

The other subset are people afraid to leave the nest. I know one guy who did a neurology residency followed by a gazillion fellowships. We finished our residencies around the same time and by the time I saw a Facebook post about him starting private practice. I had literally been out practicing almost 6 years. Whoever is going to sacrifice 6 years of 300+/yr for a fellowship that wouldn't pay them any more than they would have made fresh out of residency needs to get their head checked out.

No specialty is still exciting after 10 years. Most are probably barely tolerable after 20.

The financial return on most pediatric fellowships is negative.

Results: Pursuing fellowship training generated widely variable financial returns when compared with general pediatrics that ranged from +$852 129 for cardiology to -$1 594 366 for adolescent medicine. Twelve of 15 subspecialties analyzed yielded negative financial returns. The differences have become more pronounced over time: the spread between the highest and lowest earning subspecialties widened from >$1.4 million in 2007-2008 to >$2.3 million in 2018-2019.

Differences in Lifetime Earning Potential for Pediatric Subspecialists - PubMed

This report can be used to help guide trainees, educators, and policy makers. The interventions discussed could help maintain an adequate and balanced pediatric workforce.

pubmed.ncbi.nlm.nih.gov

 

[deleted941485]

The financial return on most pediatric fellowships is negative.
View attachment 339127
Results: Pursuing fellowship training generated widely variable financial returns when compared with general pediatrics that ranged from +$852 129 for cardiology to -$1 594 366 for adolescent medicine. Twelve of 15 subspecialties analyzed yielded negative financial returns. The differences have become more pronounced over time: the spread between the highest and lowest earning subspecialties widened from >$1.4 million in 2007-2008 to >$2.3 million in 2018-2019.

Differences in Lifetime Earning Potential for Pediatric Subspecialists - PubMed

This report can be used to help guide trainees, educators, and policy makers. The interventions discussed could help maintain an adequate and balanced pediatric workforce.

pubmed.ncbi.nlm.nih.gov

I was shown a similar graph. I think Peds as a whole is one of the few specialties with a negative NPV.

 

[kratos99]

I work in Canada as an FM but trained in the US.

It’s definitely a lot easier in Canada. Most of us work Fee for service. See a patient bill the government. Most of my partners bill at least 300k a year. For me I also have a part time job at Workers Comp and at a Med school doing admin work. I make about 450k a year before taxes. Taxes are low as all of my private practice money goes into my Corp.

In Canada, the average gross payment for ER docs is 390K CAD....but 13% of that goes to overhead.
So that’s pretax 339K CAD income.

However, they work an average of 46.4 hours per week, not yet including on call hours. On call hours are on average 23 hours per month in direct patient care.

Let’s just take 339K CAD and divide just by 46.4 hours x 52 weeks. It comes out to 140.5/hr pay in CAD. That’s $115/hr in USD pay....BEFORE taxes (and we all know canada income taxes are much higher overall)

Source:

https://www.cma.ca/sites/default/files/2019-01/emergency-e.pdf#page14

I work in Canada as an FM but trained in the US.

It’s definitely a lot easier in Canada. Most of us work Fee for service. See a patient bill the government. Most of my partners bill at least 300k a year. For me I also have a part time job at Workers Comp and at a Med school doing admin work. I make about 450k a year before taxes. With investments (dividend income) Im up to 500k a year. Taxes are low as all of my private practice money goes into my Corp taxed at 15% up to 500k. My workers comp and admin job are both work from home. Nothing extra for health insurance. No micromanaging from the government-they just pay. I own my own practice with some partners and we run our business.

I dunno. I’ve been able to amass a net worth of 4.4m CAD (about 3.5m USD) in my years of working. Started in 2008. Basically financially independent. Partner doesn’t work. Two luxury cars, a Model 3 and an older 2012 GLK. A 2.5m dollar house. Life is pretty easy up here. I know the US system and don’t really miss it.

 

[Apollyon]

I work in Canada as an FM but trained in the US.

I'm guessing you're not in ON or QE. Just guessing.

 

[kratos99]

I'm guessing you're not in ON or QE. Just guessing.

Correct

 

[GeneralVeers]

Correct

Would have to be Alberta, as that's the only Province that doesn't have abuse Provincial income taxes.

 

[Dr Mantis Toboggan]

Raising Emergency Medicine Residency Standards | AAEM - American Academy of Emergency Medicine

AAEM was established in 1993 to promote fair and equitable practice environments necessary to allow emergency physicians to deliver the highest quality of patient care.

www.aaem.org

 

[kratos99]

Would have to be Alberta, as that's the only Province that doesn't have abuse Provincial income taxes.

No, one province left.
honestly, I don’t get the obsession with taxes. You’re gonna pay for things regardless. I probably pay more in taxes but much less in health care (and I just had surgery, daughter had surgery at 2, etc), feel fine sending my kids to a public school, etc. I mean, the biggest debates in health care right now in Canada is whether to fund a national pharmacare program and whether patients should be made to pay 20 bucks a day for parking when they go to the hospital. I laugh when Canadians have these debates as they don’t know how good they have it.
the only thing I will add is EM sucks here too. Most of my FM colleagues who did a year of emerg just went back to outpatient office based practice. It’s the same stuff I hear from the US minus the corporate BS.
its the five year specialist emerg docs that are hurting cuz you don’t have that optioned going back to PC vs the 2 year FM plus 1 year EM fellowship. More training, less options.

 

[Splenda88]

HCA Healthcare offers positions to record class of 1,982 residents and fellows

HCA Healthcare has offered 1,982 positions for its July 2021 graduate medical education programs—its largest incoming class to date.

hcahealthcaretoday.com

 

[2021Doctor]

HCA Healthcare offers positions to record class of 1,982 residents and fellows

HCA Healthcare has offered 1,982 positions for its July 2021 graduate medical education programs—its largest incoming class to date.

hcahealthcaretoday.com

Today, we’re proud to announce that we’ve offered 1,982 positions for HCA Healthcare’s July 2021 graduate medical education programs— our largest incoming class to date and the largest nationally among U.S. teaching hospitals.

 

[trekker94]

Yep. Let's make it even harder to be a EM physician while some 20 year old that took some on-line classes and shadowed for 500 hours (probably didn't even show up and just got checked off by the "provider") takes your spot while you're waiting your five years plus four plus four years

Lol PA school requires 2000 clinical hours to get accepted to. I chose med school cause it was an easier to get accepted as someone who is a great test taker.

 

[skougess]

Lol PA school requires 2000 clinical hours to get accepted to. I chose med school cause it was an easier to get accepted as someone who is a great test taker.

I, too, remember playing on my cell phone in scrubs to get my “clinical hours” as a premed.

 

[turkeyjerky]

Lol PA school requires 2000 clinical hours to get accepted to. I chose med school cause it was an easier to get accepted as someone who is a great test taker.

Yes, I also chose medicine over my true dream due to ease of entry.

People still tell me I could've been a great bartender....

 

[Splenda88]

Lol PA school requires 2000 clinical hours to get accepted to. I chose med school cause it was an easier to get accepted as someone who is a great test taker.

You are funny...

 

[sylvanthus]

Lol PA school requires 2000 clinical hours to get accepted to. I chose med school cause it was an easier to get accepted as someone who is a great test taker.

Wrong. 2000 hours is absolutely inaccurate. Shall I google a few programs for you?

 

[EMhawkeye]

PA schools far more standardized and known product than NP programs.
Worked with many PA students from University of the Sciences and PCOM.
They rotated side by side with medical students from Drexel and PCOM.
A far cry from the 500 hours of shadowing which has become the standard of these fly by night NP programs.

 

[Rekt]

PA schools far more standardized and known product than NP programs.
Worked with many PA students from University of the Sciences and PCOM.
They rotated side by side with medical students from Drexel and PCOM.
A far cry from the 500 hours of shadowing which has become the standard of these fly by night NP programs.

Why is residency constantly left out of these arguments? Sure med school put down a foundation, but residency is what sets us apart by light years. Mid-levels aren't even 1/10th as capable as a residency trained physician.

 

[trekker94]

Wrong. 2000 hours is absolutely inaccurate. Shall I google a few programs for you?

http://www.hunter.cuny.edu/artsci/repository/files/pre-health/ny-pa-program-requirements.pdf

Okay sorry "at least 1000" is the requirement. Still a lot.

 

[Matthew9Thirtyfive]

http://www.hunter.cuny.edu/artsci/repository/files/pre-health/ny-pa-program-requirements.pdf

Okay sorry "at least 1000" is the requirement. Still a lot.

Dependent on the program. Some require next to no clinical hours now.

 

[RustedFox]

I don't care how many or how few "clinical hours" a PLP program has for entry.

It's what they do (or rather don't) learn in these programs, and what they can (or rather can't) demonstrate.

Yeah, medical school is expensive, it's long, it's not easy. But it teaches you the actual science, not just "see this and do that".

People need to stop looking for the "easy way" to am outcome that they perceive as "what they want".

Do it right.

 

[EctopicFetus]

Dependent on the program. Some require next to no clinical hours now.

Yep.

PA Programs That Don't Require Healthcare Experience

The majority of US physician assistant (PA) programs require 1,000 hours or less of healthcare experience hours in order to apply to their program. 68 PA programs require more than 1000 hours of healthcare experience. For applicants who have little (or no) patient care experience, there are 96...

www.paschoolfinder.com

PA Programs That Don’t Require Healthcare Experience Hours​

1. Baylor College of Medicine Physician Assistant Program
2. Duquesne University Physician Assistant Program
3. Marshall University Joan C. Edwards School of Medicine Physician Assistant Program
4. Mary Baldwin College Physician Assistant Program
5. Northeastern State University Physician Assistant Program
6. Oklahoma State University Center for Health Sciences Physician Assistant Program
7. University of Toledo Physician Assistant Program
8. Valparaiso University Physician Assistant Program

 

[EMhawkeye]

I don't care how many or how few "clinical hours" a PLP program has for entry.

It's what they do (or rather don't) learn in these programs, and what they can (or rather can't) demonstrate.

Yeah, medical school is expensive, it's long, it's not easy. But it teaches you the actual science, not just "see this and do that".

People need to stop looking for the "easy way" to am outcome that they perceive as "what they want".

Do it right.

I concur. The "oh I've been a nurse for 5 year" mentality is the argument sham NP programs get away with 500 "clinical hours" aka shadowing as what passes for clinicals.

 

[RustedFox]

I concur. The "oh I've been a nurse for 5 year" mentality is the argument sham NP programs get away with 500 "clinical hours" aka shadowing as what passes for clinicals.

Yep.
Nursing is a cult of personality.

DumbRN: "BUT I'VE BEEN A NURSE FOR ELEVENTEEN YEARS; I KNOW WHAT IT IS THAT THIS PATIENT NEEDS."
RustedFox: "Eleventeen years? It's a shame that you don't know this by now; because you're categorically wrong."

 

[Ho0v-man]

Can’t believe people argue about how hard it is to get into med school vs a providerology program. Has anybody been managing an a sick *** patient and thought back about their MCAT studying or meaningless clinical volunteering and suddenly realized what to do? Of course not because that crap doesn’t matter.

What matters is the actual education/training for which these wannabes get comparatively none.

I don’t care how many clinical hours your “school” required when after 10 years of poorly supervised practice you don’t know what antibiotic to give in any situation and just guess randomly. Or can’t change a plan when the first line treatment doesn’t work. Or can’t entertain the idea that the diagnosis the nurse put on the chart before you walked in was wrong.


PAs come out about as good as a third year med student two weeks into the rotation at best.

NPs come out as a nurse who did online discussion board posts for two years.

They need to stay in subspecialized fields doing 1-2 things and nothing else. They need to stay out of primary care/EM because they don’t have the knowledge to deal with an undifferentiated patient. They literally peak after decades of practice at the level of a PGY-1 at the few things they do. Can’t believe this crap is legal.

I don't care how many or how few "clinical hours" a PLP program has for entry.

It's what they do (or rather don't) learn in these programs, and what they can (or rather can't) demonstrate.

Yeah, medical school is expensive, it's long, it's not easy. But it teaches you the actual science, not just "see this and do that".

People need to stop looking for the "easy way" to am outcome that they perceive as "what they want".

Do it right.