Emergency Medicine Wins!!! More Residency Positions

[Matthew9Thirtyfive]

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.

I agree when the rest of your post, but this is missing the point. The fact that med school is difficult to get into means that people who get into and graduate medical school have academic skills and the ability to learn and apply knowledge. That many NP programs have 100% acceptance rates means that there is no assurance that any of their graduates have any academic skills. That’s the reason people talk about admission requirements, not because it somehow improves your clinical skills.

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[Ho0v-man]

I agree when the rest of your post, but this is missing the point. The fact that med school is difficult to get into means that people who get into and graduate medical school have academic skills and the ability to learn and apply knowledge. That many NP programs have 100% acceptance rates means that there is no assurance that any of their graduates have any academic skills. That’s the reason people talk about admission requirements, not because it somehow improves your clinical skills.

I see what you’re saying. But I’m countering the whole “It’s harder to get into PA school than MD/DO” garbage they all say. Not only is it obviously untrue, but it ultimately doesn’t matter. In some alternate reality where PA/NP admissions were 10x harder the MD/DO it still wouldn’t mean anything. At the end of the day, the education and training they receive to graduate school and practice independently is still below the minimum requirements to even start residency. I have no doubt that there’s a lot of PAs out there that could succeed in med school if they were driven to do so.

 

[Matthew9Thirtyfive]

I see what you’re saying. But I’m countering the whole “It’s harder to get into PA school than MD/DO” garbage they all say. Not only is it obviously untrue, but it ultimately doesn’t matter. In some alternate reality where PA/NP admissions were 10x harder the MD/DO it still wouldn’t mean anything. At the end of the day, the education and training they receive to graduate school and practice independently is still below the minimum requirements to even start residency. I have no doubt that there’s a lot of PAs out there that could succeed in med school if they were driven to do so.

Oh yeah. I know what you’re getting at. I’m just saying it’s not a completely irrelevant argument because it does have some importance in how reliable these people are once they graduate.

But to your point, yes I 1000% agree with you.

 

[trekker94]

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."

Lol kinda pathetic how SDN gets off on demeaning other fields. Y'all really have nothing else going for you but being a physician. Just focus on being the best you can be, not putting others down. Glad to know I've been sticking to medReddit, will continue to do so. Cespool of no life med students/residents on here.

 

[aim-agm]

Lol kinda pathetic how SDN gets off on demeaning other fields. Y'all really have nothing else going for you but being a physician. Just focus on being the best you can be, not putting others down. Glad to know I've been sticking to medReddit, will continue to do so. Cespool of no life med students/residents on here.

We will not miss you.

 

[RustedFox]

We will not miss you.

Dunning-Kruger is strong with this one.

 

[Dred Pirate]

Lol kinda pathetic how SDN gets off on demeaning other fields. Y'all really have nothing else going for you but being a physician. Just focus on being the best you can be, not putting others down. Glad to know I've been sticking to medReddit, will continue to do so. Cespool of no life med students/residents on here.

it isn't an airport - no need to announce your departure (I generally hate that comment - but its true here)

But seriously - I am not a physician - I come here because I appreciate the good cases, and learn some. But the point of of these NP/PA discussions is that their are many that feel somehow they are superior to physicians - which is just straight up bull - I work with some that are great (mainly in the ED or part of the cards/intensivist team) - those that successful at their job are those that know what they are there for, and what their limitations are. But holy cow are some just absolutely effing clueless. (and you could likely say the same about my profession). It seams like half of the RN's I work with are in some online NP program - I feel sorry for them, because I pretty sure a large percentage are just throwing their money away and have no business becoming a "provider"

 

[Matthew9Thirtyfive]

Glad to know I've been sticking to medReddit, will continue to do so.

Enjoy your antisemitic, red pill rage site.

 

[Apollyon]

Leaving SDN for Reddit is like saying you're trading in your Explorer for a Yugo.

 

[ER BlueBlood]

Maybe but people love their dermatologist and they have the advantage of not being hospital based.

Derm offices are like walking into a car dealership or shopping mall, their whole practice and advertising is kind of embarrassing but you are right, women (at least my wife lol) always want to buy something from the derm

 

[southerndoc]

Another EM residency just got approved: Emergency medicine residency

Dignity Health East Valley wherever that is. AZ?

 

[hopefulgasman]

Oh hell yes. Maricopa, all the UA campuses, Kingman, Abrazo who had the most difficult time trying to fill their spots, and now Dignity who will probably start with a robust 10-12 residents per class, not 6 of course, because of the absolute need of the underserved region.

Stay away from EM.

 

[Rekt]

Another EM residency just got approved: Emergency medicine residency

Dignity Health East Valley wherever that is. AZ?

Absolutely unreal. I really hope med students continue to realize how absurd this is. Arizona market was absolutely crushed by Covid and it’s still difficult to find any decent job there. The last thing it (or all of EM) needs is another residency.

 

[GonnaBeADoc2222]

Another EM residency just got approved: Emergency medicine residency

Dignity Health East Valley wherever that is. AZ?

More like Indignity Health

 

[GonnaBeADoc2222]

Absolutely unreal. I really hope med students continue to realize how absurd this is. Arizona market was absolutely crushed by Covid and it’s still difficult to find any decent job their. The last thing it (or all of EM) needs is another residency.

All the Caribbean students with 220 USMLE salivating.

 

[MechEDoc]

There is no dignity in dignity health. I've worked in their system, patients and staff are treated like dirt.

 

[Fpg1245]

There is no dignity in dignity health. I've worked in their system, patients and staff are treated like dirt.

You should always assume the opposite of whatever adjective a corperation uses to describe itself.

Prime health = Subprime
Dignity = Shame
Charity hospital = **** you pay me

 

[hopefulgasman]

HCA Los Robles in beautiful Thousand Oaks California says hold my beer y’all. Located about 30 miles west of UCLA in a city with a mean household income of 113K per year, this underserved region must be in dire need of EM physicians because we all know Southern CA is one of the least saturated markets in the nation…

Forget about LAC USC in addition to UCLA Olive View and Harbor UCLA each pumping out about 20 residents per class per year right next door. Oh, and how about those Central Cali residencies just a few hours north such as UCSF Fresno (couldn’t fill their class), Kaweah (filled about 3/13), and Kern (all IMGs now) who got absolutely crushed in the match.

 

[Fpg1245]

HCA Los Robles in beautiful Thousand Oaks California says hold my beer y’all. Located about 30 miles west of UCLA and a city with a mean household income of 113K per year, this underserved region must be in dire need of EM physicians because we all know Southern CA is one of the least saturated markets in the nation…

Forget about LAC USC in addition to UCLA Olive View and Harbor UCLA each pumping out about 20 residents per class per year right next door. Oh, and how about those Central Cali residencies just a few hours north such as UCSF Fresno (couldn’t fill their class), Kaweah (filled about 3/13), and Kern (all IMGs now) who are crushed in the match.

I hope they come from wealthy families or married to a tech entrepreneur. I see no reason to smile.

They desperately need EM docs…cheap docile ones

 

[southerndoc]

The residency proliferation needs to stop. The RRC needs to get rid of all the people approving these residencies.

Of course Los Robles is an HCA hospital. Didn't see that one coming.

 

[FlaminHotER]

The gutting of our speciality continues

 

[Splenda88]

The gutting of our speciality continues

IM will be next. Hospitalists are having a great time right now.

 

[Siggy]

HCA Los Robles in beautiful Thousand Oaks California says hold my beer y’all. Located about 30 miles west of UCLA in a city with a mean household income of 113K per year, this underserved region must be in dire need of EM physicians because we all know Southern CA is one of the least saturated markets in the nation…

Forget about LAC USC in addition to UCLA Olive View and Harbor UCLA each pumping out about 20 residents per class per year right next door. Oh, and how about those Central Cali residencies just a few hours north such as UCSF Fresno (couldn’t fill their class), Kaweah (filled about 3/13), and Kern (all IMGs now) who got absolutely crushed in the match.

Well, if you're going to go all the way up to Fresno and Kaweah, you might as well go South to UC Irvine (Orange CA), UC San Diego, as well as East where you have Arrowhead (Colton, CA... basically San Bernardino), Loma Linda, Riverside Community/UC Riverside, Riverside University Health System (new name for Riverside County Hospital) Desert Regional (Palm Springs), and Eisenhower (Rancho Mirage).

 

[hopefulgasman]

Well, if you're going to go all the way up to Fresno and Kaweah, you might as well go South to UC Irvine (Orange CA), UC San Diego, as well as East where you have Arrowhead (Colton, CA... basically San Bernardino), Loma Linda, Riverside Community/UC Riverside, Riverside University Health System (new name for Riverside County Hospital) Desert Regional (Palm Springs), and Eisenhower (Rancho Mirage).

don’t forget UHS Temecula.

 

[Siggy]

don’t forget UHS Temecula.

What is it with the high need for EM physicians in the California desert?

 

[doggydog]

Most people think every area in California is LA/SD/SF.

 

[FlaminHotER]

At this point it is clear and evident that hospital systems and CMGs have figured out that opening free standing EM residency equates to cheap labor

Additionally, med students with $300K in debt would rather take a $120 hr paying job than no job

Continue driving down the market

There’s no other justification for this madness

 

[EctopicFetus]

What is it with the high need for EM physicians in the California desert?

Need bodies. Not docs. Residents are mostly dumb and usually cheap.

 

[Ubba]

Can someone please either explain or recommend a resource that explains how residencies end up making significant amounts of money for hospitals? I honestly can't understand it. Say Medicare pays ~150k/year per resident and that resident is getting ~60k in salary + thousands of dollars worth of benefits. So we're left with 80k in profit so far. But that doesn't factor in the administrative costs of the residency and the fact that if I'm an attending, I'm probably not trusting a resident's history, physical, or clinical judgment until at least the middle of 2nd year, and even then, I'm going to have to double-check everything. Does having residents actually increase attendings' clinical output? Because it seems to me like it would do the opposite. Or maybe the growth curve really ramps up toward the middle/end of residency and that portion makes up for the slow start...?

If having residents does increase your efficiency, how large would you estimate that effect to be?

 

[Clean7795]

Can someone please either explain or recommend a resource that explains how residencies end up making significant amounts of money for hospitals? I honestly can't understand it. Say Medicare pays ~150k/year per resident and that resident is getting ~60k in salary + thousands of dollars worth of benefits. So we're left with 80k in profit so far. But that doesn't factor in the administrative costs of the residency and the fact that if I'm an attending, I'm probably not trusting a resident's history, physical, or clinical judgment until at least the middle of 2nd year, and even then, I'm going to have to double-check everything. Does having residents actually increase attendings' clinical output? Because it seems to me like it would do the opposite. Or maybe the growth curve really ramps up toward the middle/end of residency and that portion makes up for the slow start...?

If having residents does increase your efficiency, how large would you estimate that effect to be?

Let's use other specialties as examples.

A neurosurgery resident works on average about 80 hours/week plus call. If a hospital were to hire a midlevel to take on admissions and handle floor work it could cost 120-150k by itself, and still not approach the same number of work hours as a NSx resident who has additional duties (helping out in the OR, more invasive procedures, etc.) & overnight work. Most surgical residents fall into this spectrum.

A senior radiology resident putting out preliminary reports is covering whatever it would cost to hire a nighthawk telegroup to put out prelims (or internal locums for the radiology group).

A senior anesthesia resident definitely increases the output of an attending and will also have rotations covering ICU. A CRNA costs 200k+.

A senior medical resident covering all admissions is doing work that would otherwise be done by a nocturnist.

 

[cyanide12345678]

My residency attendings averaged 3.5 pph because everyone was seen and taken care of by residents. This is an established 40+ year old program. Imagine just sitting on a computer, watching orders, adding any orders you want, not really worrying about the note, not having to make any phone calls to consultants. And if it’s a 2nd year resident and above, literally they functioned mostly independently. Interns needed help, but really they don’t see that many patients anyway.

Try seeing that volume yourself in community medicine.

I swear we had two attendings who mostly would just be shopping during shift on Amazon. One attending who no longer works there literally would disappear for prolonged periods of time. And i mean prolonged disappearances!!!! and the 3rd year senior essentially ran the department lol.

Try doing that in the community.

So yeah…definitely residents add to efficiency. I wish i had a resident doing all my notes.

 

[Fox800]

My residency attendings averaged 3.5 pph because everyone was seen and taken care of by residents. This is an established 40+ year old program. Imagine just sitting on a computer, watching orders, adding any orders you want, not really worrying about the note, not having to make any phone calls to consultants. And if it’s a 2nd year resident and above, literally they functioned mostly independently. Interns needed help, but really they don’t see that many patients anyway.

Try seeing that volume yourself in community medicine.

I swear we had two attendings who mostly would just be shopping during shift on Amazon. One attending who no longer works there literally would disappear for prolonged periods of time. And i mean prolonged disappearances!!!! and the 3rd year senior essentially ran the department lol.

Try doing that in the community.

So yeah…definitely residents add to efficiency. I wish i had a resident doing all my notes.

Same. One of hours vanished for hours. Like, hours. Wouldn't respond to pager or cell phone, so the other attending babysat their POD or w/e. Found passed out with South Park playing in the office. They've published enough that no one cares, and the dude is like 45-50.

 

[NYEMMED]

My residency attendings averaged 3.5 pph because everyone was seen and taken care of by residents. This is an established 40+ year old program. Imagine just sitting on a computer, watching orders, adding any orders you want, not really worrying about the note, not having to make any phone calls to consultants. And if it’s a 2nd year resident and above, literally they functioned mostly independently. Interns needed help, but really they don’t see that many patients anyway.

Try seeing that volume yourself in community medicine.

I swear we had two attendings who mostly would just be shopping during shift on Amazon. One attending who no longer works there literally would disappear for prolonged periods of time. And i mean prolonged disappearances!!!! and the 3rd year senior essentially ran the department lol.

Try doing that in the community.

So yeah…definitely residents add to efficiency. I wish i had a resident doing all my notes.

Maybe we went to the same residency.

I one of my attendings left for hours on shift, never saw a patient, and just clicked on sign for the notes. Senior resident ran the ED pod

 

[EctopicFetus]

Avg em volume is like 1-8-2.2 pph. I have seen academic at 3+. All that labor is “free” as it is paid by someone else. Need a central line the resident does most of the work. Maybe you hop in for a minute.

 

[FlaminHotER]

My residency attendings averaged 3.5 pph because everyone was seen and taken care of by residents. This is an established 40+ year old program. Imagine just sitting on a computer, watching orders, adding any orders you want, not really worrying about the note, not having to make any phone calls to consultants. And if it’s a 2nd year resident and above, literally they functioned mostly independently. Interns needed help, but really they don’t see that many patients anyway.

Try seeing that volume yourself in community medicine.

I swear we had two attendings who mostly would just be shopping during shift on Amazon. One attending who no longer works there literally would disappear for prolonged periods of time. And i mean prolonged disappearances!!!! and the 3rd year senior essentially ran the department lol.

Try doing that in the community.

So yeah…definitely residents add to efficiency. I wish i had a resident doing all my notes.

Literally exact same experience I had at my program

Seniors ran the dept and did the majority of teaching

Interns would report to the seniors

Attendings then would do “teaching” rounds near the end of the shift

 

[FlaminHotER]

Let's use other specialties as examples.

A neurosurgery resident works on average about 80 hours/week plus call. If a hospital were to hire a midlevel to take on admissions and handle floor work it could cost 120-150k by itself, and still not approach the same number of work hours as a NSx resident who has additional duties (helping out in the OR, more invasive procedures, etc.) & overnight work. Most surgical residents fall into this spectrum.

A senior radiology resident putting out preliminary reports is covering whatever it would cost to hire a nighthawk telegroup to put out prelims (or internal locums for the radiology group).

A senior anesthesia resident definitely increases the output of an attending and will also have rotations covering ICU. A CRNA costs 200k+.

A senior medical resident covering all admissions is doing work that would otherwise be done by a nocturnist.

UNM (New Mexico) NSGY program closed down.

I believe They had to hire 4x as many NPs than NSGY residents to help cover the service

 

[qwerty89]

Well, if you're going to go all the way up to Fresno and Kaweah, you might as well go South to UC Irvine (Orange CA), UC San Diego, as well as East where you have Arrowhead (Colton, CA... basically San Bernardino), Loma Linda, Riverside Community/UC Riverside, Riverside University Health System (new name for Riverside County Hospital) Desert Regional (Palm Springs), and Eisenhower (Rancho Mirage).

Lol Eisenhower. When I interviewed there for intern year they told me the average patient age was Medicare range.

 

[emergentmd]

1. EM is getting skull Fked because we are essentially the easiest residency to open up.
2. EM is test case and will be replicated for other specialists. Its supply and demand. When demand is high, supply will be increased at all costs. I am talking about you IM, rad, OB, GS, Etc
3. Nothing will change until The supply/demand curve gets to steady state and opening new residencies have little economic benefit.

Getting Free and paid for "doctors" are the quickest way to fix a supply issue.

I run an HCA hospital, can't find a doc to work for less than $250/hr. My ER sees 100ppd so I need 50 hr EM doc coverage or $4.5M/yr even if I could find these docs. I have a $2M hospital shortfall. I open up a 8 class EM program = 24 residents.

Now I have 24hr EM doc coverage plus 8 EM residents working daily for 96 hr EM resident coverage or 1pph/resident.

HCA CEO essentially saved the hospital 2.25M and have bunch of scut monkeys doing other stuff when slow. You have an EM attending doing very little work other than signing charts, and peeking into rooms. A competent EM attending every hour can look at the 25 room ER, do a 10 min board run, 10 min peek in for sicker pts, and have 40 minutes every hour to go get coffee. The vast majority of attending's time is talking to pts, charting, procedures, disposition. Take that away with residents and it becomes an extremely easy job.

 

[trackrunner321]

Can someone please either explain or recommend a resource that explains how residencies end up making significant amounts of money for hospitals? I honestly can't understand it. Say Medicare pays ~150k/year per resident and that resident is getting ~60k in salary + thousands of dollars worth of benefits. So we're left with 80k in profit so far. But that doesn't factor in the administrative costs of the residency and the fact that if I'm an attending, I'm probably not trusting a resident's history, physical, or clinical judgment until at least the middle of 2nd year, and even then, I'm going to have to double-check everything. Does having residents actually increase attendings' clinical output? Because it seems to me like it would do the opposite. Or maybe the growth curve really ramps up toward the middle/end of residency and that portion makes up for the slow start...?

If having residents does increase your efficiency, how large would you estimate that effect to be?

A new program now has 8 new resident physicians. Guess what else happens? A couple attending FTEs gets cut because there are now new residents to take their place and be supervised by the remaining attending shift that did not get cut.

 

[CajunMedic]

I one of my attendings left for hours on shift, never saw a patient, and just clicked on sign for the notes.

Had something similar on overnights. One attending in particular, once they trusted you, would go sleep in an empty room unless a stroke/trauma/cardiac alert came in or a transfer needed to be accepted. This particular assignment was only you and the attending, I wound up running the department by myself most nights with them when I was a senior.

 

[Dr Mantis Toboggan]

UNM (New Mexico) NSGY program closed down.

I believe They had to hire 4x as many NPs than NSGY residents to help cover the service

Yup at my med school in the 90s the PGY2 neurosurgery resident was on call every day except for the 2 weeks of vacation they got and the 2 months of neurology they did in Chicago (my school was in downstate IL and the PD shipped them up to the big city for that).

They took one resident per class and that first year of neurosurgery was absolute hell from what I witnessed.

 

[fiji128]

This will give one a sense for how the open market values residency positions.

Hahnemann residency programs draw winning bid of $55M from local health systems.​

Hahnemann residency programs draw winning bid of $55M from local health systems

A group of six local health systems outbid Reading-based Tower Health for the residency slots that had been assigned to Hahnemann University Hospital.

whyy.org

 

[Oligodinero]

Sutter Roseville, CA is hiring attendings. Under the job description it says they're starting a new EM program this summer.

 

[Aslanim]

A list of newly accredited Emergency Medicine residency programs over the past year:
Doctors Hospital at Renaissance, Ltd. Program
University of Texas Medical Branch Hospitals Program
NYU Long Island School of Medicine Program
Geisinger Health System (Wilkes Barre) Program
Central Iowa Health System (Iowa Methodist/Iowa Lutheran) Program
HCA Healthcare/Los Robles Regional Medical Center Program
Lakeland Regional Health Program
Dignity Health East Valley Program

To be fair there's a lot of newly accredited Family Medicine and Internal Medicine programs as well.

 

[emergentmd]

A list of newly accredited Emergency Medicine residency programs over the past year:
Doctors Hospital at Renaissance, Ltd. Program
University of Texas Medical Branch Hospitals Program
NYU Long Island School of Medicine Program
Geisinger Health System (Wilkes Barre) Program
Central Iowa Health System (Iowa Methodist/Iowa Lutheran) Program
HCA Healthcare/Los Robles Regional Medical Center Program
Lakeland Regional Health Program
Dignity Health East Valley Program

To be fair there's a lot of newly accredited Family Medicine and Internal Medicine programs as well.

The best way to increase supply, increase residency. You are going to see many more med schools opening up or FMG taking spots at this rate.

 

[Apollyon]

I see Wilkes-Barre on On Patrol Live, so, maybe it will be good?

And maybe pigs will fly!

 

[VA Hopeful Dr]

A list of newly accredited Emergency Medicine residency programs over the past year:
Doctors Hospital at Renaissance, Ltd. Program
University of Texas Medical Branch Hospitals Program
NYU Long Island School of Medicine Program
Geisinger Health System (Wilkes Barre) Program
Central Iowa Health System (Iowa Methodist/Iowa Lutheran) Program
HCA Healthcare/Los Robles Regional Medical Center Program
Lakeland Regional Health Program
Dignity Health East Valley Program

To be fair there's a lot of newly accredited Family Medicine and Internal Medicine programs as well.

There's still a large unmet demand for both FM and IM.

 

[Oligodinero]

A list of newly accredited Emergency Medicine residency programs over the past year:
Doctors Hospital at Renaissance, Ltd. Program
University of Texas Medical Branch Hospitals Program
NYU Long Island School of Medicine Program
Geisinger Health System (Wilkes Barre) Program
Central Iowa Health System (Iowa Methodist/Iowa Lutheran) Program
HCA Healthcare/Los Robles Regional Medical Center Program
Lakeland Regional Health Program
Dignity Health East Valley Program

To be fair there's a lot of newly accredited Family Medicine and Internal Medicine programs as well.

Did I just read that Kaiser is acquiring Geisinger recently? If so will this mean that Kaiser is quickly becoming a force in EM GME?

 

[fiji128]

Did I just read that Kaiser is acquiring Geisinger recently? If so will this mean that Kaiser is quickly becoming a force in EM GME?

Correct. The amount of corporate speak about how everyone wins would have me very worried as a patient or a "provider" in this system.

Kaiser Permanente’s acquisition of Geisinger could reveal ‘art of the possible’

Kaiser Permanente is forming a new health organization called Risant Health, and Geisinger will be the first member. Healthcare experts see enormous promise and some open questions.

www.chiefhealthcareexecutive.com

 

[AlvinKamara]

Sutter Roseville, CA is hiring attendings. Under the job description it says they're starting a new EM program this summer.

Oh my godddddd. UC Davis is like 10 miles away. What a joke. The docs that train at programs like this should not be taken seriously when applying for jobs. What kind of crappy experience are they even getting here?